Kodi ndi chowopsya chotani pa khansara? Kwa ambiri, ndi khansara ya mwayi ingabwerere atatha opaleshoni. Ndi khansa yambiri ya khansa, mawere, ubongo, khansa ya khansa , kapena mapapo, mwachitsanzo-izi zimakhala zapadziko lonse. Khansara ya prostate, komabe, ndi yosiyana. Zingakhale zovuta kukhulupirira, koma amuna omwe ali ndi matenda obwereranso amafa chifukwa cha ukalamba kusiyana ndi khansa ya prostate.
Khansara ya Prostate Ndi Yosiyana
N'chifukwa chiyani kachilombo ka prostate kamabwerera mosiyana kwambiri? Zifukwa zingapo. Choyamba, imakula ndikufalikira pang'onopang'ono kusiyana ndi mitundu ina ya khansa. Chachiwiri, mankhwala omwe amachititsa kuti testosterone (hormonal blockade) ayambe kugwira ntchito mochititsa mantha. Amuna amapita ku chikhululukiro kwa zaka 10! Koma chomwe chimapangitsa khansara ya prostate kukhala yapadera kwambiri ndi mtundu wina wa mapuloteni opangidwa mu prostate gland wotchedwa prostate-specific antigen, wotchedwa PSA.
PSA Ndi Yodabwitsa
Ngakhale kuyesa kuchuluka kwa PSA m'magazi a munthu kuti awonetsere kuti khansara yatsutsidwa mwamphamvu, PSA ndiyoyeso ya golide yowona matenda obwereranso. Ndipotu, mitundu ina ya khansa ilibe ngakhale yomwe ikugwirizana ndi kulondola kwa PSA. PSA imadziwa kansa yaing'ono kwambiri. Mwamwayi, khansa zina zimangowoneka ngati zowonongeka, pambuyo pa ziwalo zowonongeka zimakhala zazikulu kuti ziwoneke ndi maso.
Kuti matumbo awonedwe pawunikira, ayenera kukhala oposa theka ndi inchi ndipo ali ndi maselo angapo a khansa imodzi . PSA mayeso a magazi, kumbali inayo, amazindikira kuti pangakhalenso maselo 100,000.
PSA Nthawi Yokhumudwitsa Ndi Yolondola Kwambiri Kuposa Gleason Score
Kuzindikira kubwereza ndi PSA kumayambiriro koyambira kumapatsa mwayi wakuzindikira kufunika kwa kubwezeretsedwa.
Kuyesedwa mobwerezabwereza kwa PSA-kunena ndi magazi pamwezi kumatenga-kuchuluka kwa kuwonjezeka kwa PSA kungatsimikizidwe molondola. PSA kaŵirikaŵiri, amadziŵika kuti amayamba kubwerera. Mfundoyi ndi yofunika kwambiri chifukwa kuchepetsa kuyambiranso kumachitika mosiyana kwambiri ndi kubwereza kwapamwamba.
Anthu ambiri amadziŵa kale njira ya Gleason, njira yodziwika kwambiri yothetsera khansa mwa amuna omwe angophunzira kumene , ndiko kuti, asanabwererenso . Ndi dongosolo la Gleason, maselo a kansa amathandizidwa ndi dokotala wapadera wotchedwa pathologist. Wodwala matendawa amawona chithunzi cha biopsy pansi pa microscope ndipo amapereka kalasi ku khansa . Ndondomeko ya Gleason ndiyo chisonyezero champhamvu kwambiri chokhazikitsa khansa ya prostate yomwe yatulukira kumene ndipo ili ndi mbali yofunikira kwambiri popanga chithandizo chabwino kwa amuna omwe angoyamba kumene kupeza. Komabe, mu kansa ya prostate yowonongeka, nthawi ya PSA yowirikiza mobwerezabwereza imatsimikizira kulondola kwa chiwerengero cha Gleason. Kudziwa za kukula kwa khansa ndiyo njira yeniyeni yothetsera vuto la khansa, ndipo mwatsoka, PSA imatsimikizira izi ndi zosayerekezeka.
PSA nthawi yotsatizana ya PSA imasonyeza kuti kubwezeretsedwa kwakukulu, njira yothetsera imayendetsedwa.
Chithandizo chimasiyanasiyana kwambiri poyerekezera ndi kawiri kawiri kawiri ka mankhwala, kotero kuti mtundu wa mankhwala opambana pa kalasi iliyonse ya kubwerezabwereza ikufotokozedwa pansipa.
Ophunzira Ochepa Ochepa
Zolongosola zofotokozera, zizindikiro zitatu zobwereza zikhoza kufotokozedwa: otsika, pakati, ndi apamwamba. Kudziwa kuti nthawi yayamba kubwereranso ndi chifukwa chosankhira mankhwala. Ena amabwereranso, mwachitsanzo, ali ochepa kwambiri kuti palibe mankhwala omwe adzafunike. Izi zimachitika pamene PSA imafuna zoposa chaka kuti iwirirenso. Pamene nthawi yotsatizana ndi yochepetseratu, njira yabwino kwambiri ndi kuletsa chithandizo ndikupitiriza kuyang'anira PSA miyezi itatu kapena isanu ndi umodzi.
Ambiri mwa odwalawa amakhalabe odwala mpaka kalekale.
Maphunzilo apakati-Kubwereranso
Pamene amuna ali ndi PSA nthawi ziwiri zomwe zimakhala zovuta, muzinena kwa miyezi isanu ndi umodzi kapena khumi ndi iwiri, iwo amakhala odwala mwa njira ina. Kalekale, mankhwala akhala akuphatikizidwa ndi mpweya wosawonekera kumalo a thupi limene prostate linalipo asanachotsedwe. Malo omwe akuwunikira amatchedwa prostate fossa. Nthawi zina ma radiation amagwiritsidwa ntchito mwanjira imeneyi adzakhala ochizira. Kafukufuku amasonyeza kuti mankhwala ochizira amatha bwino ngati mankhwalawa atayambika PSA isanakwere pamwamba pa 0.5. Mofanana ndi mitundu yambiri ya khansa yothandizira, chithandizo choyambirira chinayamba bwino.
Thandizo la Hormonal
Ngati mankhwalawa sagonjetseka, mankhwala otchedwa hormonal mankhwala ndiwo njira yotsatila yotsatira. Njira yodziwika kwambiri ndiyo kusankha wothandizira kuchokera ku mndandanda wautali wa mavitamini omwe amagwira ntchito mofanana-Lupron, Trelstar, Eligard, Firmagon, kapena Zoladex. Mankhwalawa amayesedwa ngati kusungidwa ngati ma radiation satha kulamulira PSA yowonjezereka. Ma masepa a khansa ya prostate amafuna testosterone kuti apulumuke, ndipo mankhwalawa amathandiza kuchepetsa testosterone. Kutaya maselo a khansa a testosterone amawachititsa kufa. Kutsekemera kwa mahomoni kumapangitsa kuti thupi likhale lolimba lomwe limasungidwa kwa zaka khumi, poganiza kuti mankhwala amayamba mwamsanga, ndiko kuti, asanayambe minofu ya metastases. Kutha kwa matenda ndi kochepa kwambiri ngati khansara ya prostate imaloledwa kulowa mafupa asanayambe kulandira chithandizo.
Thandizo Labwino
Pochepetsa kuchepa kwa testosterone, kawirikawiri maphwando ochizira nthawi zambiri amalimbikitsidwa. Njira yachizolowezi ndiyo kuyang'anira Lupron kwa miyezi isanu ndi umodzi kapena eyiti ndikupita tchuthi. Kawirikawiri PSA imachepetsera zosakwana 0.1 mkati mwa miyezi isanu ndi umodzi yoyamba mankhwala. Pambuyo pa mankhwalawa ataimitsidwa ndipo zotsatira zake zatha, testosterone imayamba kupuma ndipo PSA imayamba kuwuka. Lupron yachiwiri ikuyamba pamene PSA ikukwera kumalo osamveka, kunena pakati pa zitatu ndi zisanu ndi chimodzi. Kafukufuku amatsimikizira kuti njirayi imayendetsa bwino khansa komanso ngati Lupron imaperekedwa mosalekeza.
Mtundu Wopangira Matenda a Hormone
Nthawi zina mankhwala oopsa a mahomoni monga Casodex (bicalutamide), omwe ali ndi Avodart (dutesteride) kapena popanda Avodart, angalowe m'malo mwa Lupron kuti athetse mavuto. Njira yotereyi ingasankhidwe, mwachitsanzo, kwa odwala omwe ali okalamba kapena odwala. Zotsatira zofala kwambiri zomwe zimagwirizanitsidwa ndi njira yoyenera yowonongeka ya mahomoni-kutopa, kufooka, ndi kulemera-zimakhala zochepa kwambiri. Komabe, pali zotsatira imodzi zomwe zimakhala zofala kwambiri ndi kukula kwa khungu la Casodex. Vutoli, komabe, likhoza kutsutsana ndi pilisi yoletsa yotchedwa estrogen yotchedwa Femara. Momwemonso, mlingo wokwanira wa ma radiation womwe umatetezedwa kumtunda usanachitike Casodex imapeweratu kukulitsa mawere.
Kuchiza Ophunzira Aakulu Ophunzira
Amuna omwe ali ndi kansa ya prostate yobwezeretsanso nthawi yomwe PSA ikuwombera nthawi yosachepera miyezi isanu ndi umodzi ikukumana ndi vuto lalikulu. Ngati matendawa sakuyang'aniridwa ndi mankhwala othandiza, khansara imafalikira mofulumira ndikukhala pangozi. Apa, njira yabwino kwambiri yothandizira anthu ndi njira yowonongeka yomwe imadalira njira zochiritsira zomwe zimaperekedwa panthaŵi imodzimodziyo, aka njira zambiri. Zotsala za nkhani ino zidzakambilana ndi mankhwala omwe amapita mobwerezabwereza.
Zithunzi za Art-of-the-Scans
Njira yoyamba ndiyo kugwiritsa ntchito zipangizo zamakono zowunikira kuti mudziwe kuti m'thupi muli khansara. Pakalipano, minofu yabwino kwambiri yomwe ilipo yowonongeka (ma lymph nodes ndi malo oyamba a metastases) ndi C 11 Acetate kapena C 11 Choline PET. Mwamwayi, ku United States izi zowoneka zimapezeka pa Phoenix Molecular kapena Mayo Clinic. Posachedwapa, mtundu watsopano wa PET wotchedwa Axumin wakhala wochuluka kwambiri. Maphunziro akufanizira kulondola kwa Axumin ndi C 11 PET ikuchitika. Enanso, mtundu watsopano wa PET wotchedwa Gallium 68 PSMA tsopano akulowa m'mayesero ochipatala m'madera osiyanasiyana ku US.
Kuwonjezera pa maselo amphamvu, kansalu ya prostate imafalikira ku mafupa. Kufunika kwa zolemba zoyenera kuti apeze matenda oyambirira sikungakhale kovuta kwambiri. Posachedwapa, zipangizo zamakono zogwiritsira ntchito fupa zakhala zikukula bwino pogwiritsa ntchito makina atsopano a F 18 PET. Ngati n'kotheka, F 18 PET mafupa amafunika kugwiritsidwa ntchito m'malo mwa Technisium 99 njira. Kafukufuku wa PET wa khansara ya prostate ndi chitukuko chatsopano, zomwe zimathandiza madokotala kugwiritsa ntchito miyeso yowonjezera bwino kwambiri.
Mafuta Owonjezerapo Lupron Plus Casodex
Ngati matendawa atha kukhazikitsidwa ndi kuyesa molondola, kuganiza kuti chiwerengero cha metastases ndi chochepa, (sananene zoposa zisanu), choyamba choyamba kuchipatala ndi Lupron plus Casodex ndi ndondomeko yopitilira chaka. Patapita miyezi ingapo atayamba Lupron, mavitamini amatumizidwa ku malo odziwika bwino omwe amadziwika pofufuza) komanso mankhwala enaake omwe amachititsa kuti awonongeke kwambiri ku prostate fossa komanso ku "maselo" omwe amachititsa kuti thupi liziyenda bwino. Mbali izi za thupi zimachiritsidwa chifukwa ndi malo omwe amapezeka kwambiri ndi matenda osakanikirana, ndipo ngakhale masiku ano PET amawoneka sangathe kupeza khansa pano.
Matenda a Microscopic kunja kwa Munda wa Mazira
Zofukufuku zikuwonetseratu kuti pamene ma radiation akutchulidwa pa malo odziwika bwino a matenda, kuperewera kwa khansara pa malo amenewa kumapezeka. Choncho, kulephera kwa mankhwala nthawi zambiri kumakhudzana ndi matenda ang'onoang'ono ochepa kwambiri m'magulu ena a thupi omwe sanawonekere, ngakhale kuti apangidwe kansangidwe kowoneka bwino kwambiri. Choncho, pochita ndi khansa ya prostate yoopsa kwambiri yomwe ili ndi nthawi zofulumira kwambiri, kugwiritsa ntchito njira yowopsya yomwe imagwiritsira ntchito mankhwala omwe amachititsa kuti thupi lonse lizikhala ndi mphamvu zambiri. Monga taonera kale, mankhwala opatsirana pogonana amathandiza kwambiri pamene ayamba kuchipatala poyamba, pamene matendawa ndi ochepa kwambiri.
Mankhwala Ambiri Ochotseratu Matenda a Microscopic
Popeza Lupron ndi Casodex angakhale otetezeka kwambiri pamaseŵera ochizira, ena angafunse ngati pali njira zina zothandizira zowonongeka. Pomwe funsoli lidalembedwa motere, mankhwala awiri adabwera m'maganizo mwamsanga, Zytiga ndi Xtandi. Mankhwala amphamvuwa awonetsa mphamvu zowonongeka ngakhale pamene akuchiza amuna omwe khansara yayamba kukana Lupron! Poganizira kuti iwo ali ovomerezeka ndi okhudza mankhwala, ndizomveka kuganizira m'malo mwa Zytiga kapena Xtandi kwa Casodex.
Nanga Bwanji Chemotherapy?
Kuwonjezera pa kugwiritsa ntchito mankhwala osakaniza, monga momwe tafotokozera m'ndime yapitayi, malipoti amasonyezanso kuti kuwonjezera mankhwala a chemotherapy ndi Taxotere kumatha kupititsa patsogolo kupulumuka. Ngakhale ziganizo zoterozo ziri zoyambirira, kafukufuku akuyang'ana kuphatikiza kwa Taxotere ndi Xtandi kapena Zytiga amasonyeza kuti njirayi ingakhale yotheka.
Kutsiliza
Amuna amene khansara ya prostate imayambiranso opaleshoni sangathe kulandira njira imodzi yokha ya mankhwala. Pamene nthawi ya PSA yowirikiza ndi yocheperachepera, amuna akhoza kuyang'anitsitsa mosamala. PSA nthawi yowirikiza kaŵirikaŵiri yowonjezereka, mazira, ma Lupron, kapena onse awiri angathe kuthana ndi vuto la matenda kwa zaka zoposa khumi. Amuna omwe amabwereranso mwachiwawa ndi nthawi yofulumizitsa ya PSA nthawi iwiri ayenera kuganizira mofulumira kuyambitsidwa kwa mankhwala osiyanasiyana palimodzi.
> Zotsatira:
> Kishan AU et al. Zotsatira zachipatala kwa odwala omwe ali ndi chiwerengero cha Gleason 9-10 prostate adenocarcinoma omwe amachiritsidwa ndi radiotherapy kapena prostatectomy yochuluka: Kusanthula kwa mitundu yambiri. European Urology . 71.5: 766, 2017.
> Nabid A et al. Nthawi yothandizidwa ndi arojeni kumalo opatsirana kwambiri a khansa ya prostate: Mayesero osadziwika. Journal of Clinical Oncology. 31.18 pemphani: LBA4510, 2013.
> Sandblom G et al. Mankhwala otchedwa positron emission tomography ndi C11-acetate kuti apeze chotupa ndi malo omwe ali ndi odwala matenda a prostate omwe amatha kubwerera pambuyo pobereka prostatectomy. Urology . 67.5: 996, 2006.
> Scholz M et al. Kufufuza kachilombo ka gm-csf, dose ya cyclophosphamide, ndi celecoxib pa nthawi ya psa nthawi yambiri (dt) mwa amuna omwe ali ndi khansara ya prostate ndi psa kubwerera pambuyo opaleshoni kapena kutentha. Journal of Clinical Oncology . 28.10 suppl: abstr e15061, 2010.