Pamene ndinali kuphunzitsa kuti ndikhale urologist m'zaka za m'ma 1980, mayeso a magazi a PSA omwe tsopano tikugwiritsa ntchito poyang'anira kansa ya prostate siinalipo, ndipo kupeza chotupa cha prostate kunangokhalako mwangozi.
Madokotala mwina amachitika pamutu wokayikitsa pamene akufufuza prostate wodwalayo ndi cholembera chaching'onoting'ono panthawi ya kafukufuku (wotchuka kwambiri digiti rectal exam ), kapena atapanga matenda pambuyo pa zizindikiro pomalizira pake adamupangitsa munthu kukonzekera chisankho cha dokotala kuti apeze chomwe chinali cholakwika.
Zomwezo sizinali zoyenera kuti agwire khansara ya prostate m'maseŵera ake oyambirira, ochiritsidwa kwambiri.
Zaka makumi atatu zapitazo, theka la milandu yatsopano yokhudzana ndi khansa ya prostate yomwe inafalikira kale ku ziwalo zina za thupi nthawi yomwe idawoneka. Opaleshoni yambiri ya khansa ya prostate yomwe ndimakhala ngati urology wokhalapo inachotsa mitsempha ya odwala-kuyesera kuti athetse khansa yapamwamba powapha njala ya testosterone kuti zotupa zimagwiritsa ntchito mafuta.
PSA mapulani
Kufika kwa mayeso a PSA m'zaka za m'ma 1990 kunatipangitsa kuchulukitsa kanema wa kansa ya prostate monga momwe timayang'anira makatoni a mkulu wa cholesterol ngati chizindikiro choyamba cha matenda a mtima. Anthu mamiliyoni ambiri ayesedwa, ndipo zotsatira zake zatithandiza kudziwa zithupsa zovulaza zomwe zingathe kuchitidwa bwino, monga zomwe zinachitikira Ben Stiller.
Mayeso a PSA omwe ali ndi zaka makumi asanu ndi awiri (50) angasonyeze kuti moyo wa munthu umakhala ndi chiopsezo cha khansa ya prostate ndipo amuthandize iye ndi adokotala kuti asankhe momwe angayesere kangapo.
Ngati kuwerenga sikuchepera 0.7 nanograms / milliliter (chiŵerengero cha anthu a zaka 50), chiopsezo cha moyo wa kansa ya prostate sichichepera 10 peresenti ndipo PSA zojambulazo zingakhale zofunikira zaka zisanu zokha. Ngati mlingo uli wosachepera 2 nanograms / millilita ali ndi zaka 60, chiopsezo cha khansa ya prostate yowopsa kapena kufa kwake ndi pafupifupi 2 mpaka 3 peresenti, ndipo kuyesa PSA kuyesa kungachepetse kapena kuthetsedwa.
PSA Minuses
Pamene kuyesa kwa PSA kuli kofunika, sikokwanira . Amayesa kuchuluka kwa mapuloteni otchedwa prostate-specific antigen, kapena PSA, omwe amazungulira m'magazi. PSAs amapangidwa ndi maselo mu prostate gland. Ngakhale kuti PSA yapamwamba ikhoza kukhala ndi khansara, nambalayi imakhalanso ndi matenda ena, monga matenda ndi kukulitsa kwa prostate komwe kumachitika pamene amuna amakalamba. Ngakhale mwadzidzidzi, kuwonjezeka kwa PSA kwakukulu kuchokera ku mayesero ena kupita ku yotsatira-chiyeso chotchedwa PSA velocity-si chizindikiro chodalirika chokha cha kukhalapo kwa kansa ya prostate.
Kuonjezera apo, palibe chidziwitso chodziwika bwino, cha "PAS" chonse. Amuna ambiri omwe ali ndi mitsempha ya PSA m'magazi awo alibe kwenikweni kansa ya prostate, pamene ena omwe ali ndi ma PSA otsika amachita. Palinso umboni wakuti ziwerengero za PSA ndi zizindikiro zina za PSA ndizosiyana ndi amuna a ku Africa-America kusiyana ndi azungu.
Chifukwa cha kusadziŵa kumeneku, amuna ena amafunika kuchita opaleshoni ya opaleshoni ya prostate ndipo amatha kupeza chithandizo cha khansa chomwe sichifunikira, pamene amuna ena omwe amafunikira chithandizo samapezeka mwamsanga.
Vuto Loloseredwa
Potsirizira pake, zotsatira za PSA zokha sizingaganizire za kansalu ya khansa ya prostate.
Matenda ambiri a prostate ndi owopsa kwambiri, amakula pang'onopang'ono, amachititsa zizindikiro zochepa kapena sizizindikiro, ndipo samafuna chithandizo. Ziphuphu zina zimakula mofulumira ndipo zimatha kufalikira molimba mtima kumadera ena a thupi. Mwachiwonekere ife tikufuna kudziwa mtundu wa khansara wodwalayo kuti titha kupanga malangizidwe oyenera a mankhwala, koma ma PSA sangatithandize ndi chiweruzo chimenecho.
Prothate biopsy , yomwe imapanga minofu kuchokera kumalo okayikira a ma laboratory, ingathandize kuthetsa ziphuphu ngati zochepa, zofiira, kapena zoopsa kwambiri pogwiritsa ntchito chiwerengero chotchedwa Gleason, koma ndizovomerezeka ndipo sizimangotanthauza kuti chiwopsezo chenicheni cha kansalu ndi chidziwitso.
Ndipo mfundo ya kuyesa bwino kuyesera kuchepetsa kufunikira kwa biopsies, popeza sakhala omasuka, zimayambitsa nkhaŵa ndipo zimakhala ndi zotsatirapo.
Nkhani yabwino ndi yakuti mayesero ogwiritsira ntchito bwino ndi zida zina zowunikira zikupezeka, zomwe ziyenera kutithandiza ndi "khansara / osati khansa" ndi "zizindikiro zolephereka / zachiwawa". Tiyeni tiyang'ane.
Mayesero Osanthula Kuyesera
Kuyesedwa kambirimbiri pamsika kwasonyezedwa kuti ndikulondola kwambiri kuposa kuyesa kwa PSA pakuzindikira kukhalapo kapena kupezeka kwa kansa ya prostate, komanso pozindikira kuti pali khansa yapamwamba yomwe iyenera kuchitidwa. Iwo amagwiritsidwa ntchito palimodzi ndi-osati mmalo mwa-kuyesa kwa PSA, ndipo amatanthawuza kuthandizira odwala ndi madokotala kuti asankhe ngati chiwopsezo chiri chofunikira pambuyo pa zotsatira zapamwamba za test PSA.
Mayeso a magazi kapena mkodzo ndi 4Kscore ™ , Prostate Health Index, Mi-Prostate Score, ndi ExoDx ® Prostate (IntelliScore). Aliyense amalingalira zapadera, zogwirizana ndi zogwirira ntchito, kapena zizindikiro za chilengedwe, za khansa. Ena amayeza PSA, koma m'njira zosiyanasiyana kusiyana ndi mayesero ofanana. Mwachitsanzo, mayesero (omwe sali nawo malonda) otchedwa IsoPSA ™ omwe adalembedwa ndi Cleveland Clinic ndi Cleveland Diagnostics, Inc., amafufuza kusintha kwakukulu kwa mapangidwe a maselo a PSA.
Ngakhale kuti mayesero atsopano owonetsera amachepetsa zovuta zosafunika, ngakhale Medicare kapena mabungwe omwe ali ndi inshuwalansi okhaokha amawalipira nthawi zonse (ena othandizira angawapeze pamsika wamakono) -moto, mwina, kuchokera ku nkhawa zawo zapitazo kuti mayeso a PSA apeze khansa zambiri zochepa zomwe sizinkayenera kuchitidwa. Odwala ayenera kutenga ndalama, zomwe zingakhale mazana angapo madola.
Mayesowa ndi othandiza pa nthawi yomwe sizingaoneke ngati PSA ikukwera ikuonetsa khansara, komanso odwala omwe ali ndi PSA akukwera komanso chiwonongeko choyambirira.
Njira Yabwino Kwambiri
Kwa amuna omwe ali ndi zotsatira zosazolowereka kuchokera ku mayesero awa, sitepe yotsatira ndi biopsy. Mwa njirayi timatenga zitsanzo za minofu ya prostate kuti katswiri wamagulu azifufuza pang'onopang'ono kuti aone ngati khansa ilipo. Pakhalapo posachedwapa, kupita patsogolo kuno, naponso.
Kuti tipeze minofuyi, timayambitsa singano (kuyambira 12 mpaka 24) kupita kumalo osiyanasiyana a chigoba, motsogoleredwa ndi ultrasound scan. Tagwiritsa ntchito njirayi kuyambira m'ma 1980. Prothate ndi yaing'ono, pafupifupi kukula kwa mtedza, zithunzithunzi zoterezi zimatithandiza kuyika bwino singano. Koma zojambulazo sizinatchulidwe mokwanira kuti tidziwitse zokayikitsa, zomwe zingathe kukhala ndi khansa kuchokera ku minofu yachibadwa.
Chowonadi ndi chakuti tikugwiritsa ntchito njira ya scattershot, tikuyembekeza kuti, ngati chotupa chiripo, osachepera chimodzi mwa singano adzakumana nacho. Ma biopsies osayenerera amatha kuphonya ziwalo zowononga, pamene akuwulula zina zomwe sizingatheke ndipo zingathe kukhala zosafunikira.
Mwamwayi, mawonekedwe a MRI omwe amawadandaula otchedwa multiparametric MRI akhoza kusiyanitsa pakati pa minofu yoipa komanso yoipa ya prostate.
Zingakhale zovuta kuchita zovuta pamene wodwala ali mkati mwajambuzi la MRI . Koma sitisowa. Mapulogalamu atsopano amatipanga ife kuphatikiza, kapena fuse, ma MRI ambiri omwe amatha kuwunika ndi zithunzi zamoyo, zenizeni zenizeni kuti zitsogolere singano zotsalira. Wodwala amayamba kulandira MRI. Katswiri wa zaulimi amayipenda ndondomekoyi ndikuwonetsa madera okayikitsa. Pambuyo pake, pakakhala opaleshoni yopita kuchipatala, timayika pulogalamu ya ultrasound m'malo mwa wodwalayo, pafupi ndi prostate.
Pulogalamu ya fusion imaphatikizapo MRI yomwe ilipo kale ndipo imakhala zithunzi za ultrasound. Pamene tikusanthula kafukufuku wa ultrasound kuzungulira prostate, pulogalamuyi imasintha fano la MRI molingana ndi izi, kutipatsa ife mafotokozedwe atsatanetsatane, 3-D. Titha kugwiritsira ntchito chithunzichi kuti tigwiritse ntchito masingano osokoneza bongo omwe tikufuna kuti tipeze mmalo mozembera ndikuyembekeza kuti tipeze chinachake. Zili ngati kugwiritsa ntchito GPS yanu ya foni yamakono kuti mukwaniritse komwe mukupita m'malo moyendetsa popanda njira.
Vutoli ndi njirayi, yotchedwa MRI / transrectal ultrasound (TRUS) yomwe imatsogoleredwa ndi fusion, komanso mtengo. Kuwongolera kuli pafupi $ 1,500 ndipo makampani a inshuwalansi sangathe kulipira kwa odwala omwe ali ndi biopsy yawo yoyamba. Iwo adzaphimba ngati akugwiritsidwa ntchito mobwerezabwereza kapena odwala omwe kale anapezeka ndi khansa ya prostate.
Chidutswa chotsogoleredwa chosekerera sichiri changwiro. Kafukufuku wina anapeza kuti imasowa pafupifupi mapiritsi ambiri a prostate monga momwe chiwerengerochi chilili. Koma khansa yomwe imasowa ndi yochuluka kwambiri kuti ikhale yopanda thanzi zomwe sizikusowa kuchiritsidwa. Ndipo chithunzithunzi chowongolera chithunzithunzi ndi chabwino kwambiri pakuwona zotupa zowopsa.
Kulosera Khansa Yachiwawa
Kuti tithandizire ife mochulukirapo ndi kuunika komweko, pali mayesero atsopano omwe angathe kusanthula minofu yowopsya ya zizindikiro za khansa yapamwamba. Mayesero a ma genomic - Oncotype DX ® Genomic Prostate Score, Decipher ® Kansalu ya Khansa ya Prostate, ProMark ® Proteomic Prognostic Test ndi Prolaris ® kuyesa-kuyang'ana DNA kusasunthika kumene kumatsimikizira kuti zimakula kwambiri.
Kuphatikiza apo, mayesero a Oncotype DX ndi ProMark angadziwe ngati pali khansa yowopsa kwambiri kubisala kwinakwake mu prostate, m'malo omwe sanagwirizanitsidwe ndi singano za biopsy. (Cleveland Clinic yathandizira Oncotype DX ndipo adachita nawo kafukufuku wotsimikizira Decipher ndi ProMark.)
Medicare ndi makampani ena a inshuwalansi amayang'ana mtengo wa mayesero owonetsa awa kwa odwala omwe amapeza zotsatira (matenda a Gleason omwe ndatchula kale) amasonyeza kupezeka kwa zotupa zochepa kwambiri kapena zochepa. Ambiri samalipiritsa mayesero owonetsa nthawi pamene Gleason amaonetsa ziŵeto zapakatikati kapena zoopsa.
Ndi zotsatira za mayeso awa, madokotala ndi odwala angapange chisankho chodziwikiratu cha momwe angapitirire-kaya chithandizo chamankhwala monga kuchotsa opaleshoni ya prostate, kapena kuyang'anitsitsa, zomwe zimatanthawuza kufufuza ndi kuyambiranso kafukufuku wa khansa.
Dr. Klein ndi Pulezidenti wa Glickman Urological & Impney Institute, Cleveland Clinic, mtundu wa 2 wa urology pulogalamu yomwe ikuyikidwa ndi US News & World Report.
> Zotsatira:
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> Klein EA, Cooperberg MR, Magi-Galluzzi C, et al. Mayi 17 amagwiritsira ntchito kansa ya prostate pamutu wa Gleason grade heterogeneity, chotupa multifocality, ndi chithunzi chokhazikika pansi. Eur Urol . 2014 Sep; 66 (3): 550-60.
> Hegde JV, Mulkern RV, Panych LP, ndi al. Multiparametric MRI ya khansara ya prostate: ndondomeko ya njira zamakono ndi ntchito yawo pakuzindikira khansa ya prostate ndi yomwe ikupezeka. J Magn Reson Imaging . 2013 May; 37 (5): 1035-54.
> Brawley OW, Thompson IM Jr, Grönberg H. Kupanga Malingaliro pa Kuyezetsa Khansa ya Prostate. Am Soc Clin Oncol Buku Lophunzitsa . 2016; 35: e80-7.
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