Kuonetsetsa Mwachangu, Opaleshoni, Kapena Mafunde? Zimene Maphunziro Amanena
Chifukwa cha kusagwirizana kwapangidwe koyenera, njira yosankhira khansa ya prostate yatsutsana kwambiri. Komabe, mu Oktoba 2016, nkhani ziwiri zapadera zofalitsidwa mu nyuzipepala ya New England Journal of Medicine zomwe zanena za zaka 10 zotsatila kuchokera kwa odzipereka odzipereka 1,643 omwe adalola kuti apatsidwe mwadzidzidzi (monga "kukoka") kuchipatala ndi opaleshoni, ma radiation kapena yogwira ntchito kuyang'anira.
Phunziro loyambirira linafanizira zotsatira zapakati pa zaka 10, pomwe phunziro lachiwiri, lokhazikika, linagwiritsira ntchito mafunso kuti lifanane ndi zotsatira za umoyo. Choyamba, tidzakambirana funsoli. Ndiye tikambirana za momwe moyo umakhudzidwira.
Kufunika kwa Pulogalamu Yophunzira
Kupeza odzipereka kuti athe kutenga nawo mbali mwachithandizo, m'malo mochita chithandizo, ndi kovuta kukwaniritsa. N'zosadabwitsa kuti ichi ndi phunziro lokha lomwe lafalitsidwa ndi mtundu uwu. Komabe, kuperewera kwina kuli kofunika kuti odwala mu magulu atatuwa akhale odwala komanso akhale ndi khansa ya prostate yofanana. Popanda chitsimikizo cha umoyo pakati pa magulu, zotsatira zaphunziro sizidzakhala zodalirika.
Mukudziyerekezera Nokha ku Phunziro
Chofunika kwambiri pa kufufuza kwanthawi zonse ndikuti odwala atsopano omwe ali ndi khansa angapeze zambiri zokhudzana ndi momwe njira zitatu zochiritsira zimagwirizanirana.
Komabe, kuti afanizire molondola, mbiri ya wodwalayo iyenera kukhala yofanana ndi odwala amene adayambitsa nawo phunzirolo. Kotero, tiyeni tiwerenge mbiri ya ophunzira. Amakafika zaka 50 mpaka 69, ali ndi zaka zoposa 62. PSAyi inali ya 4.6. Mmodzi mwa anayi a amunawo, dokotala amatha kumva nthendayi pa prostate ndi chala chake.
Amuna asanu ndi atatu mwa khumi aliwonse anali ndi ma PSA osachepera khumi (ngakhale panali odwala ochepa okhala ndi PSA pakati pa 10 ndi 20). Amuna atatu mwa anayi ali ndi Gleason 3 + 3 = 6., wina wachisanu anali Gleason 7, ndipo mmodzi mwa amuna makumi asanu anali ndi Gleason ambiri a 8 mpaka 10.
Kuwunika ndi Kuwunika Kwambiri
Kuwunika chirichonse chomwe chimatchedwa "khansa" sichikhala bwino ndi odwala komanso madokotala ofanana. Ndi lingaliro latsopano komanso njirayi idakalipobe. Njira yowunika mu phunziroli inadalira kwambiri PSA . Kugwiritsiridwa ntchito kwazithunzithunzi zotsatila kapena zojambula ndi MRI yambiri sizinalangizidwe zomwe si zachilendo masiku ano. Pa zaka 10 za phunziroli, pafupifupi theka la amuna omwe akuyang'anitsitsa anachitidwa opaleshoni kapena ma radiation omwe si achilendo. Mfundo yeniyeni yokhudza kuyang'anitsitsa ndi kuyang'ana amuna mwatcheru, ndipo ngati khansayo ikukula, yesetsani kuchiza chisanafike khansara.
Mphamvu ya Chithandizo pa Kupulumuka
Cholinga chachikulu cha phunziroli chinali kuyankha funso limodzi- kupulumuka. Amuna akayamba kumva kuti ali ndi khansa, ambiri amadya ndi malingaliro okhudza momwe angapeĊµere kufa kwa oyambirira. Ngati kupulumuka kuli kofunika, phunziroli likufotokoza momveka bwino kuti njira yothetsera imapangitsa kusiyana kulikonse .
M'magulu onse atatu, zotsatira zake zinali zofanana. Amodzi okha (amuna okwanira 17) anafa ndi kansa ya prostate mkati mwa zaka 10 zoyambirira. Chiwerengerochi n'chochepa ngati tiganizira zomwe zotsatirazo zikanadakhala ngati amuna omwe ali ndi Gleason 7 ndi / kapena nodule wodumpha sanatuluke pa phunzirolo. M'zaka khumi zoyambirira, panali anthu asanu ndi limodzi omwe anamwalira ndi amuna omwe ali ndi Gleason 6 komanso kufufuza kwachidziwitso. Zotsatira za chithandizo cha imfa, pazaka 10 zoyambirira, zikuwoneka zosagwirizana.
Nanga Bwanji Metastases?
Nanga bwanji pambuyo pa zaka 10?
Ili si funso lofunika kwambiri pa anthu omwe akukankhira 70; Amuna omwe ali ndi zaka za m'ma 80 amatha kufa chifukwa chosiyana. Koma ndithudi ndi funso loyenera kwa amuna omwe ali m'ma 50s. Phunziroli limalongosola kuti pangakhale chiopsezo chapadera chokhazikitsa masitima kwa gulu la amuna omwe anali kuyang'anitsitsa poyerekeza ndi opaleshoni yomweyo kapena mazira. Mwachidziwitso, amuna 29 yekha, 13 omwe anachitidwa opaleshoni ndi 16 omwe anali ndi ma radiation, ankakhala ndi metastase patapita zaka 10; pamene amuna makumi awiri ndi awiri (33) omwe anali kuyang'aniridwa anali ndi masitima . Izi zikuwerengera kuti chiwopsezo chachikulu cha 3% cha metastases ndi kuyang'aniridwa poyerekeza ndi opaleshoni yomweyo kapena ma radiation. Osati kusiyana kwakukuru, koma ndithudi ndikofunika ngati muli mmodzi wa amuna osayenerera mu magawo atatu.
Mphamvu ya Metastases pa Kupulumuka
Popeza kuti pafupifupi 50 peresenti ya amuna omwe amayamba metastases amatha kufa ndi khansara ya prostate, zikuwoneka, malinga ndi kafukufukuyu, kuti amuna omwe amachiritsidwa adzakhala ndi chiwerengero cha anthu omwe amamwalira (mwina 1 mpaka 2 peresenti) zimakhala zaka 10 mpaka 20 mutatha kupeza matenda, poyerekeza ndi amuna omwe akuchitidwa opaleshoni yomweyo kapena ma radiation. Komabe, izi ziyenera kutengedwa ndi mchere wambiri, poganizira kuti njira zogwiritsira ntchito zinali zosakwanira ndi miyezo yamakono. Monga tanena kale, amunawa anali kuonedwa ndi PSA. Iwo analibe kawirikawiri kanthana ndi MRI yambiri , komanso panalibe mafilimu osasintha omwe ankachitika panthawi yake. Odwalawa anasiyidwa bwino kwambiri kuti adziyese okha. Pokumbukira chisamaliro chodabwitsa cha kunyalanyaza, kuwonjezeka kwa metastases kuchulukitsa kwa magawo atatu peresenti kwenikweni kumawoneka kuti ndikutsika.
Kuonerera Kwasayansi Kwasintha Kwambiri
Palinso chifukwa china chochititsa chidwi kuti chiwerengero chapamwamba cha masewera omwe amapezeka mu phunziro lino chikuwonetsa ngozi yowonongeka. Mbiri ya amuna omwe anavomerezedwa mu phunziro ili siwowoneka ngati mtundu wa amuna omwe kawirikawiri akulimbikitsidwa kuti awoneke. Oposa theka la amuna omwe ali mu phunziroli anali ndi ma Gleason 7 kapena pamwamba, chotupa chokhala ndi palpable chomwe chimazindikiridwa pa digiti ya digito ya prostate, kapena onse awiri. Umenewu ndi mtundu wachisokonezo kwambiri wa khansa kuposa zomwe nthawi zambiri zimalangizidwa kuti zitsatire.
Kukonzekera kwa Zipangizo Zamakono Kupanga Opaleshoni Kapena Mafilimu?
Tisanachoke zokambirana zathu za moyo ndikupitiriza kukambirana za umoyo wa moyo, ndili ndi ndondomeko yowonjezera kuti ndipereke. Ndinatsutsa njira yophunzirayo pogwiritsa ntchito PSA kufufuza nokha monga osakwanira. Koma bwanji za njira za opaleshoni kapena zamoto? Kodi tingayembekezere kuchuluka kwa mankhwala ochizira pogwiritsa ntchito luso lamakono 2016 poyerekeza ndi zomwe amuna akuphunzirawa adalandira? Yankho lalifupi ndilo ayi. Ngakhale kuti kafukufuku wa opaleshoni ya roboti amafotokoza mofulumira machiritso, machiritso ochiritsidwa ndi chiwerengero cha chiwerewere cha kugonana ndi ukodzo sizinasinthe. Pogwiritsa ntchito miyendo yowonjezera, machiritso ndi zotsatirapo za IMRT zamakono zimakhala zofanana.
Zofunika Kwambiri pa Moyo Ngati Kupulumuka N'chimodzimodzi
Kufunafuna kuyang'anitsitsa kumakhala kosavuta ngati kutanthauziridwa kudzera mu khalidwe la moyo. Chifukwa chokhacho choletsera chithandizo chowongolera ndi chifukwa chokhazikika chomwe chimachitika kuti kugonana kwachibadwa ndi ntchito yamkodzo sikudzatha. Ngati mankhwala sakanakhala ndi zotsatirapo, aliyense akhoza kukhala ndi chithandizo; Amuna angapitirire ndi miyoyo yawo ndipo amaiwala za kuwunika kupyolera pa kafukufuku wa PSA. Komabe, tiyeni tikambirane mavuto omwe anthu amatha kuchipatala, chiopsezo chosowa komanso kusadziletsa.
Mafunsowa Asanayambe ndi Pambuyo Potsatira Chithandizo
Mu phunziro laumwini poyesa khalidwe la moyo, onse omwe adafunsapo adafunsidwa za ntchito yawo yogonana ndi kuyang'anira mkodzo asanayambe kuchipatala, 6 ndi miyezi 12 pambuyo pa chithandizo, ndi chaka chilichonse pambuyo pake. Mwachifanizirochi, opaleshoni inali yovuta kwambiri chifukwa chokhala ndi moyo wabwino. Asanapange chithandizo, 1 peresenti yokha ya amuna anali ndi ubweya wosakanikirana ndipo ankafunikira mapepala othandizira. Koma izi zinawonjezeka kufika pa 46 peresenti miyezi 6 pambuyo pa opaleshoni ndipo pang'onopang'ono anafika pa 17 peresenti 6 patapita zaka. Zaka zisanu ndi chimodzi pambuyo pa ma radiation, ndi 4 peresenti ya amuna omwe amafuna pad. Amuna asanu ndi atatu pa amuna omwe amawaika pa pulogalamuyo amafunika pedi (kumbukirani kuti pafupifupi anthu 50 pa 100 aliwonse akuyang'anitsitsa anachitidwa opaleshoni yochedwa kapena ma radiation).
Zotsatira za Chithandizo pa Ntchito Yogonana
Ndikuganiza kuti njira yabwino kwambiri yolankhulira zofufuza pa phunziro la kugonana / zotsatira zake ndi kukupatsani ndemanga yochokera ku phunziro:
"Poyambirira, amuna 67 pa 100 alionse amawafotokozera zovuta kuti athe kugonana koma ndi miyezi isanu ndi umodzi yomwe inagwera 52 peresenti mu gulu lotsogolera, mpaka 22 peresenti mu gulu la ma radiation ndi 12 peresenti mu gulu la opaleshoni. Ntchito yotchedwa Erectile inakhala yoipitsitsa mu gulu la opaleshoni nthawi zonse, ndipo ngakhale kuti panalipo 21 peresenti pa zaka zitatu, izi zinacheperanso 17 peresenti pazaka 6. Mtengo wa zaka zisanu ndi chimodzi pa gulu la ma radiation unali 27 peresenti. Mlingo wa gulu lotsogolera anali oposa 41 peresenti pazaka zitatu ndi 30 peresenti pachaka 6. "
Ngakhale kuti padzakhala kuchepa kwa nthawi yogonana pogonana kwa amuna okalambawa, zotsatira zikutitsimikiziranso kuti opaleshoni imakhudza kwambiri kuposa ma radiation kapena kuyang'anitsitsa. Monga momwe tawonera mu phunzirolo, gawo limodzi mwa atatu mwa amuna a m'badwo uno ali kale opanda mphamvu chithandizo chisanachitike. Popeza kuti anthu opanda mphamvu sangathe kukhala ndi mphamvu zowonjezereka, ndipo zotsatira zina zoipa ndizochepa, zimawoneka kuti zilibe zolimbikitsa kuti tipewe kuwala kwadzuwa mu gulu la anthu omwe alibe mphamvu.
Zotsatira za maphunziro awiri awa
Choyamba, ndalama zowonongeka ndi zofanana ndi kuchitidwa opaleshoni yomweyo kapena kuphulika kwa dzuwa mpaka zaka 10. Pofuna kuonetsetsa kuti chitetezo ndi kupulumuka zaka zoposa 10, amuna omwe akuganiza zowonongeka ayenera kuletsa kukhalapo kwa Gleason grade grade ya 7 kapena pamwambapo ndi MRI yowonjezereka yowonjezera pazotsatira ndikutsatiridwa ndi chaka. Chachiwiri, chiwerengero cha opulumuka ndi ma radiation ndi ofanana ndi opaleshoni koma ndi zochepa zowonongeka ndi kugonana. Kuwonjezera pa zotsatira zake za kugonana, ma radiation amalekerera bwino kwambiri. Ngati mankhwala akuyenera kutero, mazira ndi njira yabwino kwambiri yothetsera kansa ya prostate kusiyana ndi opaleshoni.