Pali zolepheretsa zambiri kuti mupeze chisamaliro chabwino cha kansa ya prostate . Choyamba, monga momwe tidzaonera kumapeto kwa nkhaniyi, khansara ya prostate ndi yovuta, zomwe zikutanthauza kuti kuyeza njira yabwino kwambiri kungakhale kovuta. Chachiwiri, chidziwitso chosasinthika ndi chatsopano cha pa intaneti ndi chowopsya komanso chosadabwitsa. Madokotala , osadwala odwala, athawike.
Chachitatu, nthawi yotsatizana pakati pa odwala ndi madokotala ikupitirirabe chifukwa cha kukula kwa bizinesi yayikulu ndi boma kupita kuchipatala. Pamwamba pa mavutowa, ganizirani momwe pafupifupi madokotala omwe sanagwiritse ntchito posankha mankhwala . Amangogwiritsa ntchito opaleshoni kapena ma radiation, choncho kupanga kupanga chisankho kumachokera kwa wodwalayo.
Kodi Odwala Ayenera Kusankha Mapulani a Chithandizo?
Madokotala amene amasamalira odwala khansa ya prostate amadziwa zofooka zomwe tazitchula pamwambapa. Ndipo amadziwa kuti palinso mavuto ena. Choyamba ndi chakuti madokotala ali ndi mkangano waukulu wa chidwi. Amalipidwa kuti achite mtundu umodzi wokha wa mankhwala, opaleshoni kapena ma radiation . Chotsatira chake, iwo sakufuna kupereka malangizo othandiza. Kodi odwala amamva kangati kuchokera kwa dokotala, "Iwe uyenera kukhala yemwe akuganiza"?
Chachiŵiri, kuneneratu kuti matenda a kansa ya wodwala ndi ovuta kwambiri ndi khansa ya prostate yomwe imakhala yochepa kwambiri .
Zimatenga zaka khumi kuti chigamulo cha chisankho chichitike. Malingaliro akusowa kwambiri ndi okalamba omwe ali ndi odwala khansa ya prostate. Kufa kuchokera ku ukalamba nthawi zambiri kumakhala koopsa kwambiri kusiyana ndi khansa yokha. Potsirizira pake, pa nkhani ya khansa yofatsa, yofulumira kwambiri, zotsatira za chithandizo pa umoyo-zinthu monga zopanda mphamvu kapena kusadziletsa-zikhoza kukhala zazikulu kuposa momwe zimakhudzira moyo.
Kodi ndi ndani amene angakhale woyenera kugwirizanitsa zinthu zapamwamba ndi moyo kuposa wodwalayo?
Kudziwa Gawo Lanu
Kuchita nawo njira yopangira chithandizo ndizosapeŵeka kwa odwala khansa ya prostate. Kusankhidwa kwa mankhwala kumayambira pa sitepe ya khansa, msinkhu wa wodwala, ndi zolinga zake zapamwamba. Chotsatira chake, kudziwa kansalu ya khansa n'kofunika kwambiri:
- Amachepetsa chiwerengero cha mankhwala omwe amachititsa ndipo amapewa kufunika kofufuza zinthu zambiri zosafunikira.
- Zimalimbikitsa kulankhulana kwa dokotala. Madokotala amatha kudumpha pazomwe akufotokozera za siteji ndikudumpha kukambirana mofananako za mankhwala omwe amagwiritsidwa ntchito kawirikawiri pa sitepe yeniyeniyo.
- Ndi njira yabwino kwambiri yodziwira moyenera za chiopsezo cha khansara ndi kufulumizitsa (kapena kusowa kwake) pofuna chithandizo choopsa (onani m'munsimu).
Milandu Isanu ya Buluu
Pali magawo asanu akuluakulu a kansalu ya prostate - Sky, Teal, Azure, Indigo, Royal -ach yomwe ili ndi zitatu subtypes yotchedwa Low, Basic ndi High , kwa chiwerengero cha khumi. Miyendo itatu yoyamba, Sky, Teal, ndi Azure , imakhala yofanana kwambiri ndi zoopsa zomwe zimakhala zovuta za matenda a Low, Intermediate, ndi High Risk omwe adayambitsidwa ndi Anthony D'Amico wa Harvard Medical School.
Indigo ndi Royal amaimira kansa ya prostate yowonongeka komanso yowonjezereka . Pali machitidwe ena angapo, koma onse ali ndi zofooka. Masitepe okha a Buluu amaimira khansa yambiri ya prostate.
Kuopsa Kokufa Khansara ya Prostate
Chimodzi mwa zopindulitsa kwambiri pakugwiritsira ntchito masitepe ndikuti chimapereka kuzindikira kuopsa kwa matendawa, chomwe ndi chimodzi mwa zinthu zofunika kwambiri pakupeza chithandizo chabwino. Chithandizo chachikulu chiyenera kukhala chokwanira ndi matendawa. Mankhwala ochepetsa khansa amayenerera kuchipatala. Khansa yaukali imafuna mankhwala opweteka.
Kupirira zovuta zokhudzana ndi chithandizo sikuvomerezeka ngati khansa ndi yofatsa, pamene zotsatira zina zitha kuvomereza pamene matenda owopsya alipo. Phunziro 1 limasonyeza momwe chiopsezo cha imfa chimasiyanasiyana pakati pa magawo.
Phunziro 1: Kuopsya Kwa Kufa Pakati
Gawo la Blue | Mgwirizano wa Chithandizo Amakonzedwa Kwambiri | Kuopsa Kokufa | % ya Gawo Lodziwika Kwatsopano |
Mlengalenga | Palibe | <1% | 50% |
Kutha | Okhazikika | 2% | 30% |
Azure | Kutalika | 5% | 10% |
Indigo | Mod. Kwa Max. | <50% | 0% |
Royal | Kutalika | > 50% | 10% |
Chofunika Chofunika: Tebulo pamwambapa likuwonetsa kuti mlingo wa mankhwala ochiritsidwa ndi 80 peresenti ya amuna amene atulukira kumene ( Sky ndi Teal ) mwina amatha kapena alibe.
Nthawi Yomwe Imfa Imachokera ku Khansa ya Prostate
Khansa ya prostate imakhala yosiyana kwambiri ndi khansa zina, makamaka momwe zimakula pang'onopang'ono. Mwachitsanzo, imfa ya khansara yamapapu kapena kansa ya pancreatic ikhoza kuchitika m'chaka choyamba cha matenda. Kudziwa kwathu ndi mitundu yoopsya ya khansara kumalongosola chifukwa chake liwu lakuti "khansa" limayambitsa mavuto ambiri. Khansara, tikuganiza, ikufanana ndi imfa yomwe ili pafupi. Koma yang'anirani momwe ziŵerengero za pa Table 2 zimasonyezera momwe kansalu ya prostate imachitira mosiyana.
Pulogalamu 2: Kupulumuka kwa Kansa ya Prostate yatsopano
Chiwerengero cha Survival | Tsiku Loyamba la Kuzindikira | |
Chaka 5 | 99% | 2012 |
Chaka 10 | 98% | 2007 |
Chaka 15 | 94% | 2002 |
Zaka zoposa 15 | 86% | Zaka za m'ma 1990 |
Taganizirani kuti ziwerengero za kupulumuka zimangotchulidwa ndi nthawi; Kufa kwa zaka 10 kungathe kuwerengedwa kwa amuna omwe anapezeka kuti abwereranso mu 2007, ndipo mwa masiku ano, chithandizo cham'mbuyomo chinali chosasinthika. Choncho, ziŵerengero za moyo zomwe zimadalira zipangizo zamakono zakale sizikhoza kuimira chiyembekezo cha wodwala amene akudwala mankhwala lero. Kupulumuka kumapitirirabe kukhala bwino ndi nthawi, ndipo, ngati chili chonse, amuna omwe ali ndi khansa ya prostate yosala pang'ono amakhala ndi nthawi.
Njira Zina Zopangidwira Zosakwanira
Amuna akafunsa madokotala awo, "Ndili ndi siteji yanji?" Kawirikawiri samadziwa kuti pali machitidwe osiyanasiyana omwe amagwiritsidwa ntchito. Tiyeni tiwone mwachidule machitidwe ena otsogolera:
- Maphunziro a kachipatala (A, B, C, ndi D) amafotokoza makamaka momwe prostate imamvera pa kuwerengera kwa digito (DRE). Ndondomekoyi inakhazikitsidwa PSA isanayambe kupangidwa ndipo amagwiritsidwa ntchito ndi opaleshoni kuti adziwe ngati ntchito ya prostatectomy yokwanira imavomerezedwa (Onani Table 3).
- Zolemba za pathologic zimakhudzana ndi kukula kwa khansara yotsimikiziridwa ndi opaleshoni kapena mwachisawawa.
- TNM Staging imaphatikizapo mfundoyi kuyambira pa 1 ndi 2 kuphatikizapo mfundo zomwe zimapezeka kuchokera ku fupa kapena CT.
- Gawo la masoka, lomwe limagawaniza amuna omwe angoyamba kumene kupezapo m'zinthu zochepa, zapakatikati, ndi zapamwamba, amagwiritsira ntchito chidziwitso kuyambira 1 ndi 2 kuphatikizapo mlingo wa PSA.
Phunziro 3: Kutsegulira kwachipatala (DRE Stage)
Gawo | Kufotokozera |
T1 : | Kutupa komwe sikungamveke konse ndi DRE |
T2 : | Kutupa kumakhala mkati mwa prostate T2a: Kutupa mu <50% ya lobe imodzi T2b: Kutupa mu> 50% ya lobe imodzi koma osati ma lobe onse T2c: Kutupa kunamveka m'malabe onse awiri |
T3 : | Kutupa komwe kumadutsa mu capsule ya prostate T3a: Kutambasula kwa Extracapsular T3b: Kutupa komwe kumalowa mthupi (seminal vesicle) |
T4 : | Kutupa komwe kumalowa mu rectum kapena chikhodzodzo |
Mbali za Mitsinje ya Blue
Stage ya Blue dongosolo imagwiritsa ntchito machitidwe ena onse (1, 2, 3 ndi 4 omwe ali pamwambapa), kuphatikizapo akuphatikizapo chidziwitso chokhudza ngati opaleshoni yakale kapena ma radiation apita kale.
- Kuwerengera kwa ma rectal: Momwemonso vs. nodule vs. misa
- Gawo la Gleason : 6 vs 7 vs. 8-10
- PSA: <10 vs. 10-20 vs. 20
- Mapulogalamu a chiwopsezo: Ndi ochepa poyerekeza ndi kuchuluka kwa ndalama zambiri
- Chithandizo cham'mbuyomu: Inde vs. ayi
- Kujambula: Mliri wa matenda, kaya uli ndi mafupa kapena mafupa
Mukhoza kudziwa malo anu pa intaneti pa PCRI poyankha mafunso ochepa a mafunso pa stagingprostatecancer.org.
Kodi Cholakwika ndi Njira Yowopsa Kwambiri?
Pulogalamu yamagulu, yomwe imapangidwa ndi zigawo zitatu zapamwamba pamndandanda wazithunzi, sizinaphatikizepo zinthu zambiri zatsopano zomwe zimapangitsa kuti zikhale zovomerezeka:
- Zomwe zimachitika pa Multiparametric-MRI
- Chiwerengero cha mapepala a biopsy omwe ali ndi khansara
- Zosintha za PET
Pamwamba pa izo, gulu lachiopsezo silimaphatikizapo amuna omwe abwereranso matenda, amuna omwe amatsutsidwa ndi mahomoni, kapena amuna omwe ali ndi metastase mu mafupa.
Mukadziwa Gawo Lanu, Ndi Chithandizo Chiti Chabwino Kwambiri?
Chofunika kwambiri podziwa malo amodzi ndi chakuti amalola odwala ndi madokotala kuti azikhala osamala kwambiri. M'mawu otsalawa, njira zina zothandizira chithandizo zimayikidwa pa magawo onse.
Mlengalenga
Popeza kuti Sky (Low-Risk) ndi chinthu chopanda phindu, ndipo popeza tsopano tikudziwa kuti Gleason 6 sanagwirizane nazo, kutchula kuti "khansa" ndizovuta kwambiri. Momwemo, Sky ingatchulidwe ngati chotupa chochititsa manyazi osati khansara. Choncho, mitundu itatu yonse ya Sky , ( Low, Basic ndi High) imayang'aniridwa ndi kuyang'anitsitsa. Chiopsezo chachikulu kwa abambo ku Sky ndi kulephera kuzindikira mphamvu zapamwamba zamatenda. Choncho kuyesa mwakhama ndi MRI yambirimbiri pa malo omwe ali ndi khansa yodziwika bwino ndi yochenjera.
Kutha
Msanga (Wopakati-Woopsa) ndi chikhalidwe chochepa chokhala ndi chiyembekezo chabwino chokhala ndi moyo kwa nthawi yaitali. Komabe, amuna ambiri amafuna mankhwala. Chokhachokha ndi Chakudya Chapafupi , chomwe chimayang'anitsitsa chovomerezeka n'chovomerezeka. Kuti muyenerere kukhala otsika-teal the Gleason ayenera kukhala 3 + 4 = 7, osati 4 + 3 = 7, kuchuluka kwa Grade 4 mu biopsy ayenera kukhala osachepera 20 peresenti, 3 okha kapena ochepa biopsy cores akhoza kukhala ndi khansa, palibe core akhoza kukhala oposa 50 peresenti m'malo mwa khansa, ndipo zina zonsezi ziyenera kukhala ngati Sky .
Makhalidwe Oyikidwa ali ndi makwinya ambiri okhala ndi khansara kuposa otsika, koma akadali oposa 50 omwe alipo. Amuna Omwe Amakhala ndi Matenda Aakulu Ambiri ndi oyenerera kuti athe kugwiritsa ntchito njira zina zamakono zamakono, kuphatikizapo mapiritsi a mbewu, IMRT, Proton therapy, SBRT, mankhwala a mahomoni, ndi opaleshoni.
Mkulu wazitsamba umaphatikizapo zifukwa zilizonse zoyenera kwa wodwala wamatenda omwe sagwirizana ndi Low kapena Basic . Nsonga yapamwamba imakhala yamphamvu kwambiri ndipo imayenera kuchitidwa ndi mankhwala osakaniza omwe amaphatikizapo IMRT, mbewu, ndi mankhwala a hormone a miyezi inayi kapena sikisi.
Azure
Kuthamanga (Kwakukulu-Kuopsa) kumakhalanso ndi magawo atatu. Kutsika Kwambiri ndi Gleason 4 + 4 = 8 ndi biopsy cores, kapena palibe biopsy core kuposa 50% okhudzana ndi khansa, ndi zina zonse monga Sky . Amuna omwe ali otsika kwambiri amachitilidwa mofanana ndi Matenda Aakulu.
Choyambirira-Choyambirira ndi mtundu wofala kwambiri wa Azure ndipo umayimira chirichonse mu gulu la Azure lomwe limalephera kukwaniritsa zofunikira za Low kapena High . Msinkhu wakumwamba umatetezedwa ndi ma radiation, mbewu, ndi mankhwala a mahomoni kwa miyezi 18.
Mwamba-Azure amatanthauza chimodzi kapena zambiri mwa izi: PSA zoposa 40, Gleason 9 kapena 10, oposa 50 peresenti ya biopsy cores, kapena khansa m'magazi a m'mimba kapena m'mimba. Mwamba-Azure amafanana ndi Basic-Azure, ngakhale mwina ndi kuwonjezera kwa Zytiga, Xtandi, kapena Taxotere.
Indigo
Indigo imatanthawuza kuti khansara imachitanso opaleshoni kapena mazira. Kaya indigo ndi yotsika, Basic kapena High imatsimikiziridwa ndi khansara yomwe imafalikira mu nthiti za m'mimba. Low-Indigo amatanthauza kuti chiopsezo n'chochepa. Kuti muyenerere kukhala Low-Indigo, PSA iyenera kukhala <0.5 pambuyo pa opaleshoni yapitayi kapena <5.0 pambuyo pa miyezi yapitayi. Komanso, nthawi yawiri ya PSA iyenera kukhala> miyezi 8. Kuonjezera apo, gawo loyambirira la Buluu asanachitike opaleshoni kapena ma radiation ayenera kuti anali Mlengalenga kapena Mtsinje. Chithandizo cha Low-Indigo chingakhale ndi ma radiation (pambuyo pa opaleshoni yapitayi) kapena salvage cryotherapy (pambuyo pa miyezi yapitayi).
Basic-Indigo imatanthawuza kuti zofufuza ndi zofufuza siziwonetsa maselo omwe amadziwika (odziwika ngati mets), koma njira zabwino zomwe tazitchula pamwambapa za Low-Indigo sizitsimikizika. Mwa kuyankhula kwina, chimodzi kapena zingapo za zinthu zosiyanasiyana zimasonyeza kuti mavitamini apamwamba kwambiri amakhalapo. Kwa Basic-Indigo , mankhwala ophatikizana omwe amachititsa kuti mankhwalawa asagwiritsidwe ntchito poyerekeza ndi mazira a mitsempha ndi mankhwala a mahomoni ayenera kugwiritsidwa ntchito.
High-Indigo amatanthauza kuti zimapezeka kuti zilipo m'magulu a mimba. Mankhwala a High-Indigo ndi ofanana ndi Basic - Indigo kupatula kuti mankhwala owonjezera ndi Zytiga, Xtandi, kapena Taxotere angaganizidwe.
Royal
Amuna a ku Royal akhoza kukhala ndi mphamvu ya mahomoni (PSA yopuma ndi testosterone yapamtunda) kapena metastases kupitirira kapena kunja kwa nkhono zapakhosi (kapena zonse ziwiri). Low-Royal ndi kukana kwa ma hormone popanda metastases. Amunawa nthawi zonse amakhala ndi matenda ochepa kwambiri koma sangathe kuwoneka ndi minofu kapena CT. PET yatsopano, yamphamvu kwambiri monga Axumin, PSMA, kapena Carbon 11 ingayesedwe kuti ipeze metastases. Momwe metastases aliri, mankhwala adzakhala ofanana ndi Basic-Royal .
Basic-Royal ndi matenda osokoneza bongo (kunja kwa pakhosi) koma chiwerengero cha metastases ndi zisanu kapena zochepa. Chithandizo cha Basic-Royal ndi kuphatikiza SBRT kapena IMRT ku malo onse odziwika bwino, Perekani immunotherapy, kuphatikizapo Zytiga kapena Xtandi.
Mkulu-Royal amatanthauza kuti zoposa zisanu zamtunduwu zimapezeka. SBRT kapena IMRT ndi masastases ambiri nthawi zambiri sizothandiza. Ngati matendawa sakuyenda mofulumira kapena opweteka, chithandizo chiyenera kukhala ndi Zopereka zotsatiridwa ndi Zytiga kapena Xtandi. Matenda opweteka kapena ofulumira akuyenera kuperekedwa ndi Taxotere.
> Zotsatira:
> D'amico, Anthony V., et al. "Chotsatira chokhazikitsira zolemba za adenocarcinoma zam'deralo za prostate." Journal of urology 158.4 (1997): 1422-1426.
> Frank, Steven J., et al. "Zomwe zimayambitsa matendawa ndi prostate brachytherapy kwa khansa ya prostate yomwe ili mkati mwawo: zotsatira zake, zowononga, komanso khalidwe labwino." International Journal of Radiation Oncology * Biology * Physics (2017).
> Zotsatira za khansa ya prostate 2017. https://www.cancer.net/cancer-types/prostate-cancer/statistics
> Sylvester, John E., ndi al. "Zaka 15 zapachilengedwe zimayambiranso kupulumuka ku kachipatala kanjira ya kanema ya prostate T1-T3 potsatira kansalu kamodzi kokhala ndi radiotherapy komanso brachytherapy; International Journal of Radiation Oncology * Biology * Physics 67.1 (2007): 57-64.