Popeza pali mitundu itatu yoopsya ya khansa ya prostate yatsopano, mankhwala ochepa komanso apamwamba kwambiri amasiyana. Kawirikawiri, njira yathu ndikulangizira odwala omwe ali ndi chiopsezo chotere, mbewu zowonjezera kwa amuna omwe ali ndi chiopsezo chapakatikati, ndi kuika mbewu pamodzi ndi mankhwala owonjezera kwa amuna omwe ali pachiopsezo chachikulu . Zosankha izi zinachokera pa kafukufuku yemwe anayerekeza zotsatira pakati pa mankhwala osiyanasiyana.
Kupanga Opaleshoni Kapena Kupanga Mafuta a Beam?
Komabe, akatswiri ambiri sagwirizana. Mwachizoloŵezi, mitundu iwiri yokha ya njira zochiritsira, opaleshoni kapena mazira owala, amaperekedwa ndi madokotala opaleshoni ndi odwala ma radiation, madokotala omwe nthawi zambiri amagwira amuna ndi khansa ya prostate. Mbeu zamagetsi, zomwe zimatchedwanso brachytherapy, nthawi zambiri zimachoka pa zokambiranazo.
Kwa zaka zambiri, zakhala zikuchitika pazokambirana pakati pa opaleshoni ndi ma radiation, funso liri, "Kodi njira imodzi ndi yabwinoko?" Ndipo mwa "bwino", tithandaule: chithandizo chomwe chili ndi mankhwala opambana kwambiri ntchito?
Anthu akhala akuganiza kuti opaleshoni ndi ma radiation ali ndi zotsatira zofananako, koma kufanana kwasayansi kwapamwamba kudziwa ngati wina ali wabwinoko kusiyana ndi winayo akusowa. Choncho, odwala komanso madokotala adadalirapo maganizo ndi malingaliro awo pazidziwitso, komanso zomveka bwino.
Komabe, amuna akufunafuna mayankho tsopano akudalitsidwa ndi chitukuko chatsopano chokhazikika-kufalitsa kwa mutu wa mutu ndi mutu, kuyerekezera kwachidziwitso kuchipatala kuyerekezera opaleshoni, ma radiation, ndi kuyang'anitsitsa.
Mayesero osinthika ndi apadera chifukwa amayankha funso lokhazikika , pofuna kuthetseratu kusokoneza, vuto lalikulu ndi mayesero obwerezabwereza (kuposa makumi asanu ndi anayi mphambu asanu ndi anayi pazoyeso za mayesero oyerekeza opaleshoni ndi kuwunika kwa dzuwa ndikutembenuka).
Chifukwa chake pali zochepa zoyembekezera mayesero ndikuti ochita kafukufuku amafunika kupeza odwala omwe akufuna kulandira chithandizo mwachisawawa. Mlanduwu ukutchulidwa m'munsimu, amunawa adayenera "kukoka" kuti adziwe omwe angachite opaleshoni, ma radiation kapena kuyang'anitsitsa pulogalamu yotchedwa "randomization".
Kafukufuku wambiri wofufuza nthawi zonse wakhala alipo, kuyesa kufanizitsa zotsatira za ma radiation ndi opaleshoni. Zili zodetsedwa, komabe, ndi zinthu zambiri zovuta, chitsanzo chimodzi kukhala nthawi yoyenera ya odwala. Kawirikawiri, amuna achichepere amapatsidwa opaleshoni ndipo amuna achikulire amachizidwa ndi ma radiation.
Kuyerekeza monga izi ndi kosavomerezeka chifukwa ndizodziwika bwino kuti anyamata amakhala ndi zotsatira zabwino ngakhale atalandira chithandizo chotani. Mpaka pano, popeza "deta yeniyeni" yomwe yakhala ikudziwika kuchokera ku magulu osalingana, madokotala akhala omasuka kuti asankhe phunziro lililonse lothandizira kuti likhale lothandizira kuteteza malo omwe mankhwalawa ali apamwamba kuposa ena.
Kuonetsetsa Mwachangu
Ndiye bwanji pasanakhalepo deta iliyonse yowunikira kuyerekezera opaleshoni, ma radiation, ndi kuyang'anitsitsa? Choyamba, mayeso oterewa ndi okwera mtengo kwambiri. Amuna ambiri amafunika kuyang'aniridwa kwa zaka zoposa khumi.
Chachiwiri, zimakhala zovuta kupeza amuna omwe ali okonzeka kukoka chithandizo cha mankhwala. Chachitatu, popeza mayesero amatenga nthawi yaitali, kulenga chiyeso chotero kumafuna kuwona masomphenya kuti pakhale funso loyankhidwa ndi yesero lidzakhala loyenera zaka 15 m'tsogolomu.
Monga zovuta monga zosawerengeka, zowonongeka ziyeso zimayenera kulipira ndi kuchita, zikufunikira kwambiri. Kulephera kwa mayesero osokonezeka nthawi zonse kumayambitsa kutsutsana ndi kusagwirizana. Popanda kudziwitsutsa, kusankhidwa kwa mankhwala kumathera kutsogoleredwa ndi ndalama - chithandizo chomwe chimapereka chabwino chimakhala chotchuka kwambiri.
Choncho, posindikizidwa posachedwapa kwa maphunziro angapo osadziŵika bwino poyerekeza mozama ndi zotsatira za chithandizo cha opaleshoni, ma radiation, ndi kuyang'anitsitsa ndizochitika zakale. Izi ndizochitika zozizwitsa zomwe zimatipangitsa kuti tidziwe kumapeto kwake.
Mu September 2016, nyuzipepala ya New England Journal of Medicine inafalitsa nkhani yakuti "Zotsatira Zaka Zaka 10 Zotsatira za Kuwunika, Kuchitidwa Opaleshoni, kapena Radiotherapy kwa Khansa ya Prostate Canal". Mu mayeserowa, amuna okwana 1650 anapatsidwa mwayi wopenda, opaleshoni, kapena ma radiation, ndikutsatira zaka khumi. Mtundu wa amuna omwe adachita nawo mchitidwewu unali wofanana ndi munthu wamba yemwe amapezeka kuti ali ndi matenda oyambirira kudzera PSA kuwunika . Mbadwo wawo wa pakati unali 62. PSA wapakati anali 4.8.
Amuna atatu pa anayi aliwonse analibe vuto lililonse pa kuyesedwa kwawo kwa digito ya prostate ndipo gawo limodzi lachinayi linali losaoneka bwino. Pang'ono ndi atatu mwa magawo anai a amunawo anali Gleason magawo asanu ndi limodzi. Mmodzi mwa asanu mwa amunawa anali Gleason 7 ndipo mmodzi mwa amuna makumi anayi ali ndi chiwerengero chokwanira cha Gleason, cha 8 mpaka 10.
Atavomereza kuti alowe nawo mu phunziroli , amuna adapatsidwa opaleshoni yomweyo, ma radiation pomwepo kapena kuyang'anitsitsa. Anthu omwe anapatsidwa ntchito yofufuzira anadwala nthawi zonse kuti ayambe kuwayang'anitsitsa kuti athe kuchipatala.
Pa zaka 10 zomwe zakhala zikuchitika, pafupifupi theka la amuna omwe ankayang'anitsitsa anachitidwa chithandizo mochedwa ndi opaleshoni kapena ma radiation. Chochititsa chidwi n'chakuti ambiri mwa amuna omwe adawasankha omwe adasankha kuchipatala anachita zimenezi chifukwa cha maganizo m'malo momveka bwino. Mwa kuyankhula kwina, iwo anaganiza zochiritsidwa ngakhale kuti nthawi zambiri panalibe umboni wakuti matenda awo akupita patsogolo.
Magulu onse ochiritsira atatuwa adayang'anitsidwa chifukwa cha kufala kwa khansa ya prostate. Pambuyo pa zaka 10, anthu 17 anafa ndi khansa ya prostate m'magawo atatuwo, omwe amachititsa kuti peresenti imodzi ikhalepo m'magulu atatu. Koma anthu 169 anafa chifukwa cha khansa ya prostate. Anthu asanu ndi anayi (17) aliwonse anafa pa odwala omwe anali ndi chiwerengero cha Gleason choyamba cha 7 kapena kuposa. Kufa kunanenedwa ndi amuna asanu ndi atatu ndi Gleason 6 koma kuyambira pamene mayeserowa adalengedwa zaka zambiri zapitazo, matendawa adagwirizana ndi chidziwitso chosasintha kusiyana ndi kuganiza ndi MRI yambiri. Kafukufuku wambiri wasonyeza bwino kuti biopsy yosasokonezeka imasowa matenda oposa kwambiri kuposa MRI yambiri.
Chofunika kwambiri kuchotsa mayeserowa chinali chakuti pakati pa magulu onse atatu, panalibe kusiyana pakati pa chiwerengero cha anthu oposa zaka 10.
Chotsani Phunziro
Choncho malingana ndi chidziwitso chatsopano komanso chodalirika, zaka khumi za imfa za anthu zimakhala zofanana ngati wodwala akufuna kusankha opaleshoni, ma radiation kapena kuyang'anitsitsa. Bwanji za umoyo wa moyo? Nkhani yothandizana nayo yomwe inafotokozedwa pamwambayi inafalanso ku New England Journal tsiku lomwelo, kuwonetsa zotsatira zapamwamba za moyo pazochitika zitatuzi zokhudzana ndi kugonana ndi ntchito yamkodzo. Ponena za ntchito yogonana, awiri mwa atatu mwa amuna omwe ali mu phunziroli anali amphamvu asanayambe kulandira chithandizo. Pambuyo pa chaka chimodzi, chiwerengero cha amuna omwe anakhalabe potency, mwachitsanzo, anali ndi "zolimba zogonana" ndi awa:
- Kuonetsetsa mwachidwi = 49 peresenti
- Mazira a kunja akunja = 38 peresenti
- Wamphamvu kwambiri prostatectomy = 15 peresenti
Chaka chimodzi atangoyamba phunzirolo, amunawa adafunsidwa za kukhalapo kapena kusowa kwazitsulo za mkodzo zomwe zimafuna kugwiritsa ntchito mapepala. Amodzi peresenti ya amunawa anafotokoza kugwiritsa ntchito mapepala kusanayambe phunzirolo. Mavuto chifukwa cha nthawi yochulukirapo nthawi yochulukirapo inali yofanana m'magulu onse atatu ndipo anakhalabe atatha chithandizo. Pambuyo pa chaka chimodzi, chiwerengero cha omwe amagwiritsa ntchito mapepala anali:
- Kuonetsetsa mwachidwi = 4 peresenti
- Mazira a kunja akunja = 4 peresenti
- Wopambana prostatectomy = 26 peresenti
Kuphatikiza zotsatira za mayesero awiriwa, tikhoza tsopano kuyankha funso la mankhwala omwe ali ndi chiwopsezo chachikulu cha mankhwala ndi zotsatira zochepa za zotsatira zake? Kuchita opaleshoni, ma radiation, ndi kuyang'anitsitsa zonse zimakhala ndi zotsatira zofanana, koma kuyang'anitsitsa kumachitika ndi zotsatira zochepa .
Chimodzi mwa zovuta zokhudzana ndi zowonongeka zomwe zili pamwambapa ndizokuti kupititsa patsogolo khansa, kutanthauza kuti chiwerengero cha mitsempha ya mthupi sichinafanane kwambiri ndi amuna omwe anachitidwa opaleshoni kapena ma radiation poyerekeza ndi amuna omwe anayesedwa-13 ndi 16 poyerekeza ndi amuna 33. Choncho, ngati tinyalanyaza khalidwe la moyo ndikutanthauzira "mankhwala ochiza" monga "ufulu wotsutsa khansara," osati "kupulumuka", gulu loyang'anitsitsa likuchepa kwambiri kuposa opaleshoni kapena magulu a ma radiation, popanda kusiyana pakati pa opaleshoni ndi ma radiation .
Komabe, monga tanena kale, vuto lina lokutanthauzira mayesero omwe adapangidwa zaka 15 mpaka 20 zapitazo ndikuti amadalira makanema omwe angakhale osatha. Machiritso ochiritsira opaleshoni ndi ma radiation asintha pang'ono, ngati alipo, pazaka 15 zapitazo.
Komabe, njira zamakono zowunikira amuna zomwe zakhala zikuyendetsedwa bwino zakhala zikukula bwino pakufika kwa chithunzi cholondola ndi MRI yambiri. Zithunzi zamakono zimachepetsa kwambiri chiopsezo chosowa matenda osadziŵika bwino, vuto lodziwika bwino lomwe likugwirizana ndi kufufuza komwe kumadalira kuyang'aniridwa ndi biopsies osasintha. Masiku ano, zipangizo zamakono zamakono za MRI zingathe kuonetsetsa kuti pali magulu oyenera omwe angachepetse chiopsezo cha kutha kwa khansa kwa amuna omwe akufuna kuwonetsetsa.
Mitundu Yambiri Yopweteka
Chinthu chinanso chodabwitsa kwambiri cha zamakono ndicho kuzindikira kuti mbeu yowonjezereka yotulutsa mpweya imayambitsa kuchuluka kwa mankhwala ochizira kusiyana ndi kuyera kwadothi. Mu kafukufuku wina wofalitsidwa posachedwapa womwe umagwirizanitsa zotsatira za ma radiation okha ndi mazira ndi kuika mbewu, mankhwala ochiritsidwa ndi mbewu zowonjezera anawonetsedwa kuti ndi apamwamba kwambiri. Amuna onse omwe anali kuyesedwawa anali ndi vuto la khansa ya prostate yoopsa kwambiri.
Patatha zaka zisanu chithandizo chamankhwala, mankhwala ochiritsira okhawo anali 84 peresenti koma chiwerengero cha mankhwala ochizira matendawa ndi 96 peresenti. Pambuyo pazaka zisanu ndi zinayi, ubwino wambewu unali wovuta kwambiri. Popanda mbewu, mankhwalawa anali 70 peresenti ndipo 95 peresenti ya amuna omwe analandira kuwala kwa dzuwa ndi mbewu zinapitirizabe kuchiritsidwa.
Mwachiwonekere, mapiritsi a mbewu amathandizira kwambiri kuchiza mitengo. Pali chiyeso china chatsopano chomwe chimayang'ana momwe zimapangira zofiira zokha pokhapokha popanda kuwala kwina kulikonse. Mlanduwu unaphunzira amuna asanu ndi asanu ndi asanu (558) osagwirizana pakati pa ma radiation ndi mbewu motsutsana ndi mbewu zokha. Pakati pa Gleason pulogalamuyi inali 7 ndipo PSA imakhala yosakwana zaka 10. Zaka zisanu zitatha chithandizo, chiwerengero cha mankhwalachi chinali chimodzimodzi m'magulu onse awiri ndi 86 peresenti.
Zotsatira za nthawi yayitali, sizinali zochepa ndi mbewu zokha, 7 peresenti ndi 12 peresenti ya amuna omwe akulumikizana. Mayeserowa amasonyeza kuti miyezi yowonjezera imakhala yosafunikira komanso yowonjezera kuposa mbeu yomwe imaperekedwa yokha.
Kutanthauzira Deta
Kodi inu monga momwe wodwalayo amachotsera pa deta iyi? Poganizira mitundu itatu ya khansara ya prostate, kwa anthu omwe ali ndi mbiriyi, kuyang'anitsitsa ndi njira yabwino kwambiri yoyamba kwa amuna omwe ali ndi matenda oopsa. Zili ndi zotsatira zochepa komanso zotsatira zofanana ndi zomwe zimachitika opaleshoni kapena ma radiation. Tsopano kuti tili ndi njira yolondola yowawerengera amunawa kuti apange matenda apamwamba kwambiri ndi MRI yambiri, kuyang'anitsitsa kumakhala chinthu chosangalatsa kwambiri.
Amuna omwe ali ndi khansa ya prostate yapamwamba komanso yapamwamba ayenera kupatsidwa mankhwala. Kufunika kwa miyeso yowonjezerapo yazitsulo kumafunsidwa mozama. Tsopano ndi deta zodalirika kuti zithandizire njira zochepetsera zosavuta, zonse zosadziwika ndi zomvetsa chisoni zokhudzana ndi kusankha mankhwala zingathe kuchepetsedwa kwambiri.
> Zotsatira:
> American Cancer Society. Mavuto a Kansa ya Prostate.
> Cooperberg MR. Kuyezetsa khansa ya prostate kwa nthawi yayitali: mayankho ndi mafunso. J Clin Oncol. 2015; 33 (3): 238-40.
> Hamdy FC, Donovan JL, Lane JA, et al. Zotsatira za Zaka 10 Zotsatira za Kuwunika, Kuchitidwa Opaleshoni, kapena Radiotherapy kwa Khansa ya Prostate. N Engl J Med. 2016.