Mayeso abwino a kansa ya prostate ayenera kuzindikira kansa yapamwamba ya prostate pamene akupewa kuganizira kwambiri za khansa yopanda vuto, yotchedwa Gleason 6 zosiyanasiyana. Kubwerera mu 2011, bungwe la US Prestative Services Task Force (USPSTF) linalimbikitsa kupewera kuyesa kwa PSA amuna omwe ali ndi thanzi labwino chifukwa cha kuchuluka kwa mankhwala a khansa yapamwamba.
Vuto linali lopanda pake, njira yokhayo yomwe angapezeko inali kulepheretsa PSA kufufuza. Komabe, pazaka zisanu zapitazi kuchokera pamene malangizidwe oyambirirawo anapangidwa, zakhala zikuwoneka kuti chifukwa chenicheni chodziwidwa kwambiri ndi nthendayi yosawerengeka ya singano , osati PSA.
Mwamwayi, chiwerengero chapakati cha 12 chokhazikika chikupitirirabe kukhala njira yoyenera pakati pa amuna omwe ali ndi PSA yokwera. Komabe, teknoloji yamakono yatsopano imapereka njira yotsatilira kupanga chiopsezo chosasintha. Zikuoneka kuti kujambula ndi MRI yambiri (mp-MRI) ndilo malo abwino kwambiri osokoneza bongo. Chinthu chofunika kwambiri pa mp-MRI ndikuti amadziŵa molondola kansa ya prostate yapamwamba popanda kudziwa kuti palibe khansa ya prostate (Kalasi 6). Maphunziro angapo atsopano okhudzana ndi mutu uwu adaperekedwa ku msonkhano wa 2016 wa American Urology Association (AUA) ku San Diego. Nkhaniyi ikufotokoza maphunziro ofunikira awa, kutsimikizira kuti prostate imagwiritsa ntchito malo abwino kwambiri pogwiritsira ntchito MRI 3T yambiri yomwe imatulutsa khansa yapamwamba komanso imakhala ndi ubwino wambiri mwachisawawa.
The Studies Behind Prostate Test Test Test
Popeza vuto lalikulu ndi kuwunika kwa PSA ndikuti nthawi zonse zimatsogoleredwa ndi zovuta zapakati pa 12, phunziro loyambalo lomwe ndikufuna kulisonyeza likukhudzana ndi ngozi zowopsa.
Wopambana MP53-13 wolembedwa ndi Dr. Alaina Garbens, adawona momwe anthu amachitira kuchipatala nthawi zambiri atakhala ndi chiopsezo.
Anayang'ana pa chiwopsezo cha chipatala cha amuna okwana 61,910 omwe anapeza chiopsezo chachisawawa ku Ontario, Canada pakati pa January 2006 ndi December 2013. Kafukufukuyu anayezetsa kuchuluka kwa chiwerengero cha anthu odwala matenda komanso chiwopsezo cha chipatala m'masiku 30 oyambirira pambuyo pochitika prostate biopsy.
Iwo anapeza kuti mwayi wakufa kuchokera ku chikhalidwe chinali chimodzi mwa zikwi khumi. Chiŵerengero cha kuvomereza chipatala m'masiku 30 oyambirira pambuyo pa chiwerengerochi chinali 3.5 peresenti. Pa atatu peresenti, atatu mwa anai a amuna adaloledwa kuti athe kuchipatala. Monga gawo limodzi la phunziroli, Dr. Garbens adanenanso kuti chiwerengero cha zinthu zomwe zakhala zikuchitidwa chinachepera 30.6 peresenti poyerekeza ndi chiwerengero cha zinthu zomwe zinkachitika asanayambe ndondomeko ya USPSTF.
Kafukufuku wina woonjezera awiri woperekedwa ku AUA akuwonekeranso momwe mayankho a USPSTF akukhudzira mtundu wa khansa yomwe ikupezeka. Maphunziro awiriwa akuwonetsa kuwonjezeka kwakukulu kwa kalasi ya khansa yomwe imapezeka chifukwa chakuti USPSTF inapereka ndondomeko kuti asiye kufufuza.
Mfundo Zachidule MP39-04 ndi Dr. Carl Olsson adanena kuti mayankho a USPSTF m'chaka cha 2011 adatulutsidwa kuti adokotala a forgo PSA akuwonetsetsa amuna ambiri omwe amapezeka kuti ali ndi khansa yapamwamba:
Chaka | Amuna Gleason 8 mpaka 10 |
2010 2011 | 14.8% 14.8% |
2013 | 19.7% |
2014 | 25.4% |
Mwachiwonekere, kuchuluka kwa amuna omwe akupezeka kuti ali ndi khansa yapamwamba ya prostate ikuwonjezeka.
Zowoneka PD09-03 yolembedwa ndi Dr. Glen Gejerman nayenso poyerekeza kugawidwa kwa magulu atsopano omwe asanalandire ndi pambuyo pa mayankho a USPSTF. Anayesa amuna 2513 omwe adatchulidwa mu 2011 ndi 1665 omwe adatchulidwa mu 2014. Maphunziro a Gleason apakati adasintha kuchoka pa 6 mu 2011 mpaka 7 pa 2014. Maphunziro a Gleason (8-10) anapezeka pa 19 peresenti ya biopsies ya 2014 pokhapokha 9 peresenti ya biopsies yomwe inachitika mmbuyo mu 2011.
Kafukufuku wapitawo akuwonetsa kuti mayankho a USPSTF kuti asiye kufufuza PSA akuchepetsa chiwerengero cha amuna omwe akuyesedwa pa PSA.
Nkhumbayi ndi kuchepetsa kugonana kwa Gleason 6-khansa yapamwamba ya prostate ya amuna omwe amatha kusokonezeka. Izi ndizo zotsatira zokhudzana ndi mayankho a USPSTF. Pamene USPSTF inapereka malingaliro awo mmbuyo mu 2011, panalibe njira ina yothetsera biopsy 12 yosawerengeka yopenda amuna omwe ali ndi miyezo yapamwamba ya PSA. Choncho pofuna kuchepetsa vuto lalikulu la kuganizira kwambiri za matenda apamwamba, USPSTF inasankha kufooketsa PSA kufufuza kwathunthu.
Izi zikutanthawuza: Izi zowonjezera zikanakhala zomveka mu 2011. Komabe, tsopano pali teknoloji yatsopano yomwe imapereka njira yodalirika yopangira chidziwitso chosasintha.
Maphunziro asanu ndi limodzi otsatirawa omwe adalembedwa kuchokera mu msonkhano wa urology wa 2016 amasonyeza kuti MRI yowonjezereka yotsatiridwa ndi biopsy yomwe imalowera bwino imatengera kansalu ya prostate yapamwamba ndipo imatetezera vuto la kusanthula kwambiri msinkhu wa 6.
Ndondomeko MP16-17 yolembedwa ndi Dr. Yasukaza Nakanishi anawona kuti zolondola zimakhala zovuta zokhudzana ndi zilonda zokayikitsa zomwe zimapezeka ndi MRI (mp-MRI) ya prostate ya 3T. Iye anafaniziranso zotsatira za kuchita zovuta zotsatizana ndi zotsatira zomwe zimapezeka pochita biopsy 14 yosavuta. Mu phunziro lake, iye adafufuza amuna 202 okhala ndi PSA miyeso ndi MRI yambiri (mp-MRI). Zilonda zonse zokayikira zomwe zimapezeka ndi mp-MRI (PI-RADS-3 yomwe ili pamwambapa) zinalengedwa. Khansara yapamwamba "imatchedwa chiwerengero cha Gleason ≥4 + 3 kapena kuposa kutalika kwa khansa ≥5 mm. Apeza kuti biopsy yomwe inakakamizidwa inazindikira kuti 88 peresenti ya amuna omwe anali ndi khansa yaikulu ndi 97 peresenti ya amuna omwe anali ndi matenda omwe anali Gleason 8 kapena apamwamba.
Momwemo PD15-08 olembedwa ndi Madokotala. Peter Choyke ndi Peter Pinto anafufuza zomwe zimayambitsa matenda apamwamba omwe akusowa ndi chiwerengero cha anthu oposa 1003. Iwo adanena kuti chiopsezo choterechi chinaphonya Gleason 7 matenda mwa anthu 11 pa 100 alionse ndipo anaphonya Gleason 8 kapena kuposa 2 peresenti. Kuyambiranso mafomu a mp-MRI a odwalawa akuwonetsa kuti magawo awiri mwa atatu a iwo anali ndi zilonda zosawoneka zomwe adasowa ndi dokotala akumasulira . Pafupifupi zonse zotsalazo, dokotala yemwe amapanga singano ya singano amangophonya khungu. Amuna okha pa 100 aliwonse anali ndi khansa yeniyeni yosaoneka. M'mawu ena, nthawi zambiri kulephera kwa chiopsezo chofuna kulandira khansara ndiko chifukwa cha kuwerenga kwa MRI kapena kugwiritsidwa ntchito moyenera ndi dokotala yemwe amapanga singano. Mwachiwonekere, kujambula kumachita bwino, koma wodwala ayenera kuzindikira kuti sizingakhale zodalirika pokhapokha ngati zogwiritsidwa ntchito mwaluso ndi madokotala ophunzitsidwa ndi odziwa bwino.
Mayi PD15-11 olembedwa ndi Dr. Amanda Lu adayesa kuonongeka kwa mp-MRI poyerekeza ndi biopsy yopanda phindu. "Kusaganizira kolakwika" kumatanthauza kuti pangakhale kusowa khansa pamene ilipo. Amuna omwe ali ndi PSA yapamwamba omwe mp-MRI sinawonetsere zilonda zaukali zomwe zinakhala ndi zochitika 12 zapadera. Pa amuna 53 omwe ali ndi mp-MRI yosayang'ana matendawa, ndi 3,8 peresenti yokha yomwe inapezeka kuti ikukhala ndi khansara yomwe inali khansayi yofunika kwambiri (Gleason≥7) yomwe imatsimikiziridwa ndi biopsy 12.
Buku la MP21-15 lolembedwa ndi Dr. Jan Philipp Radtke linayerekezera kulondola kwa mp-MRI ndi opaleshoni. Anayesa amuna 120 omwe anali ndi mp-MRI yomwe inayendetsedwa ndi fusion yoyambira asanayambe opaleshoni. Mp-MRI inazindikira 110 (92 peresenti) ya zilonda zazikulu poyerekeza ndi zotsatira za matenda pambuyo pa opaleshoni. Mwa izi, kutsekemera kwa fusion kunapezeka 80 peresenti ya zilonda zapamwambazi. Apanso, izi zikuwonetsa kufunikira kokhala ndi madokotala aluso ndi odziwa bwino kuti azitha kuchita zinthu zomwe zimayesedwa.
Buku lopangidwa ndi MP53-02 lolembedwa ndi Dr. Joseph Mahon linalongosola zolembedwa za amuna 395 okhala ndi PSA yokwezeka chifukwa chopezeka ndi khansa ya prostate. Amuna onsewa anali ndi mp-MRI musanayambe kusinthika. Amuna opanda zilonda zazikulu amapezeka pa mp-MRI kapena ali ndi zilembo zochepa zomwe amaganiza kuti sakhala ndi khansa (PI-RADS 1-2). Amuna zana limodzi ndi makumi asanu ndi anayi mphambu zisanu ndi anayi adakwaniritsa izi ndizophatikizidwa mu phunziroli. Onsewa anali ndi chikhalidwe chokhazikika cha 12. Kawirikawiri, khansa ya prostate inalembedwa m'masamba 54 (32 peresenti) omwe 47 (88 peresenti) anali Gleason 6 kapena Gleason 3 + 4. Matenda ofunika kwambiri, mwachitsanzo, Gleason 4 + 3 anapezeka mu 10 peresenti ya amuna ndi Gleason 4 + 4 anadziwika mu 2 peresenti. Mwa kuyankhula kwina, kusaganizira kwenikweni kwa mp-MRI mu phunziroli kunali 88 peresenti.
Zosintha MP53-15 zolemba ndi Madokotala. Peter Choyke ndi Peter Pinto adafufuza kuti molondola mp-MRI fusion biopsy mu ndondomeko yambiri. Amuna omwe amaphunzirawo anali ndi mp-MRI yoyamba yomwe inatsatiridwa ndi kusakanikirana komwe kunayambanso kutsatiridwa ndi biopsy 12. Mtundu wa kansa ya prostate yomwe anaipeza inali yogawanika m'magulu atatu: Gleason 6 kapena low volume Gleason 3 + 4 = 7), Wachiwiri-Woopsa (wotchuka Gleason 3 + 4 = 7), ndi High-Risk (Gleason wa 4 + 3 kapena apamwamba).
Onse okwana 395 a biopsy-naive adadziwika kuchokera ku magulu okwana 4 omwe akugwira ntchito. Kusakanikirana kwa chiopsezo choterechi chikuwonjezeredwa ndi Matenda Oopsa kwambiri kuposa chiwerengero chapakati cha 12 (22.3 peresenti ndi 20.3 peresenti). Kuonjezerapo, kusungunuka kwa fusion kunadziwika kuti 18 peresenti yochepa ya Gleason 6 (15.7 peresenti ndi 19.2 peresenti). Kusakanikirana kosavuta kunangowonjezera amuna anayi okha omwe ali ndi Zophatikiza-Zowopsya ndipo wina yemwe ali ndi Mipira yapamwamba yomwe anapezeka ndi chiopsezo chosasintha.
Izi zikutanthawuza: Maphunziro asanu ndi limodzi apitalo amasonyeza kuti mp-MRI imayambitsa matenda okhwima omwe amawunikira kwambiri. Koma ubwino weniweni wa mp-MRI chifukwa cha chidziwitso chosasinthika ndizomwe zimawerengera m'munsi mwa khansa yapamwamba. Kukongola kwina kwa Mp-MRI ndi amuna ena omwe angathe kusiya biopsy palimodzi. Amuna omwe amafuna chiwopsezo, amafunikira kwambiri biopsy cores.
Phunziro lomaliza kuchokera pamsonkhano wa AUA womwe uli woyenera pa mutu uwu umayankhula funso la mtengo.
Wopambana MP53-14 wolembedwa ndi Drs. Peter Choyke ndi Peter Pinto kuchokera ku National Cancer Institute ku Bethesda, anafufuza kuti mtengo wa prostate wa MRI ukhale wogwira poyerekeza ndi biopsy yopanda phindu. Mtengo wa amuna 100 omwe amachitikira mwachisawawa ($ 1,410 pa munthu) ndi $ 141,035. Chidziwitso chosasinthika chikanakhala cholakwika mwa amuna 13 ndi amuna 24 olakwika.
Mtengo wa Mp-MRI wa $ 633 ndi MRI fusion biopsy ya $ 2,138. Ndalama zonse zoyenera kupeza MRI yoyamba ya prostate mu amuna 100 omwe ali ndi odwala omwe ali ndi vuto lachilonda, amadzipereka kuti akhale $ 107,961.69 popeza amuna 70 angadwale prostate MRI yekha, ndipo amuna 30 akhoza kukhala ndi chiopsezo. M'gulu la amuna omwe ali ndi prostate MRI, amuna 7 amakhala ndi zotsatira zoipa zabodza ndipo 9 angakhale ndi zotsatira zabwino zabodza. Chiwerengero chonse cha fusion chidzawononga 25 peresenti poyerekeza ndi kusokonezeka.
Izi zikutanthawuza: Kudziwa za prostate imaging pamsonkhano wapachaka wa urology ukuwonetsa kuti MRI ya 3T yambiri imasonyeza bwino khansa yapamwamba. Ubwino wokhudza chiopsezo chosasintha ndi wambiri: Kuchuluka kwa chiwerengero cha anthu omwe ali ndi Grade 6, mtengo wotsika, amuna ochepa omwe amafunikira biopsy ndi mavuto ochepa kuchokera ku chiwopsezo. Chinthu chokhacho chimene mukuyenera kukumbukira ndi chakuti chipangizo choyenera cha mp-MRI chimafuna zipangizo zamakono ndi madokotala odziwa bwino, omwe amawerenga bwino. Choncho, mpaka teknolojiyi ikukula kwambiri, mungafunikire kupita kumzinda wina kuti mutsimikize kuti mukuyesa kujambulidwa kwanu pakatikati.