Chaka chilichonse, anthu 15,000 a urologists ochokera ku dziko lonse lapansi amapita ku msonkhano wapachaka wa American Urology Association (AUA) kuti akafotokoze zomwe apeza posachedwapa pofufuza kafukufuku wa zachipatala ndikugawana zochitika za posachedwapa za khansa ya prostate. Cholinga cha May 2017 chinawonekera patsogolo pofuna njira zina zowonjezeretsa za singano 12 za singano za prostate.
Pano, tikambirana njira ziwiri zatsopanozi - OPKO 4k test test and 3T multi-parameter MRI (MP-MRI). Zonsezi zimachepetsetsa kufunikira kokhala ndi mfundo 12 zotsatizana.
Amuna oposa 1 miliyoni amatha kusokoneza chiwerengero cha 12 chaka chilichonse. Njirayi imayambitsa matenda aakulu, kusowa mphamvu, ndi mavuto ena. Choipitsitsa kwambiri, chimachititsa kuti anthu asapitirire kugonana ndi khansa ya prostate ya Grade 6 kwa azinji oposa 100,000 pachaka; pazaka khumi zapitazi, akatswiri adziwa kuti maphunziro a 6 sanagwiritsidwepo ntchito ngati khansa poyamba , popeza alibe mphamvu. Komabe, atapezeka kuti ali ndi kalasi 6-pafupifupi nthawizonse monga zotsatira za amuna 12,000 apakati pafupipafupi apakati pa 50,000 amachitika opaleshoni yaikulu kapena ma radiation kuti athetse vutoli. Ndi zophweka kuona chifukwa chake njira zina zotsatilira 12 ndi zopindulitsa komanso zosangalatsa.
Ubwino Woyesedwa Mwazi Wambiri
Msonkhano wa 2017 AUA, Dr. Stephen Freedland wochokera ku Mkungudza wa Sinai ku Los Angeles adakambilana za kukhoza kwa magazi a OPKO 4K kuti adziwe kanema ya kansa ya prostate (CSC). Izi zimatchedwa Gleason 7 kapena khansara ya prostate , mtundu wa khansara ya prostate yomwe imayenera kuchitiridwa.
Iye pamodzi ndi ofufuza ake anayerekezera mayeso a OPKO ndi PSA omwe ali ndi zifukwa zina zofunika kwambiri monga nthawi ya wodwalayo komanso kuwerengera kwa digito.
Mlanduwu unaphatikizapo amuna 366 ndi mayeso a OPKO kuti awonetsere kusintha kwakukulu kwachindunji pazowonjezereka kwa PSA kuti adziwitse CSC. Chiyesocho chinapezedwanso kuti chiri cholondola mwa amuna a ku Africa Ammera (anthu omwe ali ndi chiwerengero chachikulu cha khansa ya prostate). Popeza ndi njira yosavuta ya magazi, OPKO ndi njira yoyamba yowunikira anthu osadziwika omwe ali ndi ma PSA pamwamba pa zaka zambiri.
Zotsatira za Kujambula kwa Prostate
Poyamba, ma prostate ankawoneka mopanda chilungamo. Ngakhale pakalipano, kusinkhasinkha ndi kotheka kwambiri kuti matenda a khansa ya prostate adakalibe kwambiri pazinthu 12 zokhazokha. Ichi ndichifukwa chake kujambula ndi chimodzi mwa malo otentha kwambiri komanso ofulumira kwambiri a kafukufuku wa khansa ya prostate.
Pali zinthu zambiri zowonongeka kuti zigwirizane ndi MRI (MP-MRI):
- MP-MRI, m'malo mochita zinthu mosasinthasintha, ingakhale sitepe yoyamba yozindikira. Kusinthana koyambidwa patsogolo pa malo abwino kwambiri ndi yolondola kwambiri kuposa chidziwitso chosavuta kuti apeze kansa ya kansa ya prostate.
- Ngati kanthana kameneka kamasintha chinthu chosadziwika bwino, nthenda za singano zimatha kulunjika pang'onopang'ono kuti zikhoza kukhala zosavuta. Ngati khansa ilipo, chidziwitso chokhudza Gleason kalasi ndi cholondola.
- Cholinga cha sitepe ya khansa ndi yolondola kwambiri. Mwachitsanzo, kupweteka kwa khansa ya mitsempha ya m'mimba (kunja kwa gland) kumakhala kosavuta kupeza ndi MP-MRI kusiyana ndi chidziwitso chosasintha.
- Amuna omwe ali ndi khansa yapamwamba, omwe asankha kuyang'anira zinthu zawo ndi kuyang'anitsitsa, ali ndi njira zogwiritsira ntchito MP-MRI mmalo mochita zochitika zapakati pa 12 zokhazikika.
Chinthu chimodzi chofunika kwambiri pa zojambula za prostate chakhala chitukuko cha mawonekedwe a uniform kuti amve mawanga osadziwika (omwe amadziwika kuti "zilonda"). Chidziwitso chodziwika kwambiri, Chidziwitso cha Prostate Imaging and Data System (PI-RADS), chiwerengero cha zilonda pamtunda umodzi kufika pa zisanu. Odwala ayenera kudziwa kuti dongosololi ndi latsopano, ndipo madokotala amene amawerenga izi akuphunzirabe kugwiritsa ntchito PI-RADS kuti apindule kwambiri.
Madokotala Peter Pinto ndi Peter Choyke ochokera ku National Cancer Institute anafotokoza za kulondola kwa PI-RADS pozindikira kansa ya kansa ya prostate (CSC) yomwe imatchedwanso Gleason 7 kapena kuposa. Anayesa odwala 339 omwe anali ndi MP-MRI. Zilonda zosayembekezereka zinayesedwa mopyolera mwa kuchita zovuta zogwiritsidwa ntchito. Pamene zilonda za PI-RADS zisanu zinapangidwira, CSC inapeza 72 peresenti ya nthawiyo. Komabe, 22 peresenti ya zilonda za PI-RADS 4, 12 peresenti ya zilonda za PI-RADS 3 ndi 10 peresenti ya zilonda za PI-RADS 2 zinasonyeza CSC.
Malingana ndi mfundo zomwe zimapezeka kuchokera ku malo apamwamba kwambiri, zikuwoneka kuti ndizomveka kulingalira kuchita zochitika zokhudzana ndi amuna omwe ali ndi zilonda za PI-RADS 4 ndi 5 ndikungoyang'ana amuna pobwereza MP-MRI miyezi 6 mpaka 12 ngati PI -RADS 1, 2, kapena 3 zilonda zimapezeka.
Kodi Ma Scan Awa Ndi Olungama Motani?
Malinga ndi kafukufuku wowonjezereka mu dongosolo la PI-RADS lowerenga MP-MRI, lolembedwa ndi Dr. Gerald Andriole ndi ena, ntchito yolondola ya Maphunziro a PI-RADS ndi ma radiologist ophunzitsidwa amafunikira taluso yachibadwa, osati kungodziwa chabe. Zotsatira zolondola sizidalira pazomwe zimakhalapo nthawi yaitali ndi zowerengera zowerenga. Phunziro ili, ochita kafukufuku adawona kuwona kwa zolemba za PI-RADS kuchokera ku ma radiologist anayi osiyana siyana ndipo adapeza kuti kulondola sikunapindulidwe ndi chidziwitso chachikulu.
Mu phunziro ili, biopsy yomwe inalangizidwa idagwiritsidwa ntchito poyerekeza kulondola pamene radiologist inapereka mlingo wa PI-RADS mlingo wa 4 kapena 5, kaya biopsy inasonyeza chiwerengero cha Gleason cha 7 kapena kuposa. Mu phunziroli, zithunzi za odwalawa zidazindikiridwa ndikutsitsidwa ndi munthu wina wakhungu. Choncho, akatswiri a radiologist amatanthauzira bwinobwino prostate MRIs yonse. Kuwerenga "kolakwika" kunatanthauzidwa kuti ndi ntchito ya PI-RADS 4 kapena 5 ndi chidziwitso chotsatira chomwe chinasonyeza Gleason 6, kapena palibe khansara iliyonse. Chomwe "cholakwika" kuwerenga chinali ntchito ya PI-RADS 1, 2 kapena 3 pamene zotsatira za biopsy zinali Gleason 7 kapena pamwamba.
Kulondola kwa zolemba za dokotala kuyambira 56 peresenti mpaka 75 peresenti ndi zofufuza molondola sizinagwirizane ndi kutalika kwa chidziwitso cha dokotala kuwerenga MP-MRI. Kotero, izi zikutanthauza chiyani kwa wodwala? Zinachitika kuti kuphatikiza kwa kutanthauzira kwa ma radiologist anai onse kunapereka zotsatira zolondola kwambiri. Izi zikusonyeza kuti kutanthauzira mgwirizano wa prostate MRI kungakhale njira yowonjezera molondola.
Kodi Mphamvu za Testosterone Zimakhudzidwa Bwanji?
Tsopano MP-MRI ikuwonjezeka pakudziwika, pali funso lina lofunika, "Kodi ma tepi otsika a testosterone amachititsa bwanji kulondola kwa MP-MRI kufufuza?" Iyi ndi nkhani yovuta. Amuna akamakula, ma testosterone awo nthawi zambiri amatha. Popeza kuchepetsa testosterone kumadziŵika kukhala ndi mphamvu yokoka, zigawo zapansi za testosterone zingakhudze bwanji MP-MRI?
Phunziro lina, lochokera ku National Cancer Institute, linasanthula 522 odwala hypogonadal. PSA wawo wapakati anali 6.66 ndipo testosterone wamkati anali 171. Amuna okwana 522 anafanizidwa ndi gulu lina, lalikulu kwambiri la amuna omwe testosterone wapakati anali 311. Zotsatira zake zoganizira za magulu awiriwa zinali zofanana, ngakhale zinali zochepa chiwerengero cha khansa yofunika kwambiri m'magulu a hypogonadal (28.8 peresenti ndi 37 peresenti). Komabe, chiwerengero cha chiwerengerocho pamene chiwerengero chowongolera chinkachitidwa chinali chimodzimodzi (40.4 peresenti vs. 43.6 peresenti).
Mwa amuna 522, 78 anapita kukachitiridwa opaleshoni. Lipoti lomaliza la matenda mwa odwala 78wa, (poyerekeza ndi gulu lina la opaleshoni opatsirana ndi testosterone), linasonyeza kuchuluka kwa mapepala a Gleason (22.2 peresenti poyerekezera ndi 12.5 peresenti), kuphatikizapo masewera ambiri (11.1% vs 6.0 peresenti) ndi maulendo ambiri omwe amapezeka ku lymph node (11.1 peresenti ndi 7,5 peresenti). Malingana ndi zotsatirazi, zotsatira zazitsulo za testosterone ziyenera kuchititsa madotolo kukhala ochepa kwambiri apeza zomwe zapezeka pa MP-MRI.
Phunziro lina lochokera ku yunivesite ya California, San Francisco, linayesa momwe PI-RADS imaneneratu zotsatira za matenda pambuyo poti opaleshoni (mwinamwake mwa amuna omwe ali ndi testosterone). Phunziro ili la odwala 121, ochita kafukufuku adawona momwe PI-RADS inaneneratu kuti pangakhale mapepala apamwamba a Gleason (4 + 3 = 7 kapena apamwamba) kapena kufalikira kwa khansa kunja kwa capsule ya prostate gland. MP-MRI isanachitike opaleshoni inawonetsa kuti 69 mwa anthu 73 omwe ali ndi matenda odwala matendawa anali PI-RADS 4 kapena 5. Pamene olembawo anapeza kuti chiwerengero cha PI-RADS cha 4 kapena 5 chimakhala chovuta kwambiri kuti chidziwitso ndi chowonetseratu cholakwika ma ARV, PI-RADS 4 kapena 5 inaneneratu za matenda osokoneza bongo. Mwachitsanzo, mwa amuna onse omwe ali ndi PI-RADS 4 kapena 5 asanachitike opaleshoni, awiri okha pa atatu aliwonse ali ndi matenda ovuta.
MP-MRI imapindulitsanso mwayi wapadera pazaka 12 zokhazokha zokhudzana ndi amuna omwe akuyang'anitsitsa-njira yowonjezera yosamalira kansa ya prostate ya Grade 6. Kafukufuku wamakono wapanga kuti Gawo 6 liribe mphamvu zowonjezereka. Mwa kuyankhula kwina, sizingathe kufalikira ndipo si kwenikweni khansara. Kuonetsetsa mwachidwi kumawathandiza amuna kuti ayambe kuchitidwa opaleshoni kapena kupuma kwadzuwa kwa zaka zambiri.
Kuonetsetsa mwakhama komanso khansa ya prostate ya Grade 6
Ngati ndi zoona kuti anthu akuyang'anitsitsa sayenera kukhala okhudzidwa ndi Gawo lachisanu ndi chimodzi, chodetsa nkhaŵa kwenikweni ndi mwayi wokhala khansara ya 7 kapena yapamwamba yomwe inasowa ndi chiyambi chokhazikika mwachisawawa. Kafukufuku akuwonetsa kuti chiopsezo chosasokonekera chimasowa matenda oposa 25 peresenti ya nthawiyo. Phunziro kuchokera ku UCSF, tanena pamwambapa, linanena kuti MP-MRI imazindikira Gleason 4 + 3 = 7 kapena kupitirira 95 peresenti ya nthawiyo. Mwachiwonekere, phunziroli limatsimikizira kuti amuna omwe ali ndi Gleason 6 omwe akuganiza kuti akuyang'anitsitsa ayenera kukhala ndi MP-MRI kuti awonetsetse kuti palibe CSC yomwe inasowa ndi chidziwitso chosasintha.
Mu phunziro lina, gulu la madotolo lomwe linakhazikitsidwa ku Ann Arbor, Michigan linayang'ananso pa nkhani yopanga MP-MRI mwa amuna omwe akuyang'ana mwakhama. Anayambiranso kubwereza anthu 225, 209 ndi Gleason 3 + 3 = 6 ndi 16 ndi Gleason 3 + 4 = 7. Onse anakhala MP-MPRI atatsatiridwa ndi biopsy yoyenera ngati panali zilonda zokayikira. Zotsatira zimasonyeza kuti popanda MP-MRI, odwala 12 omwe ali ndi matenda apamwamba angakhale akusowa ndipo sakanayikidwa mosayang'anitsitsa. Chiwerengero chowoneka chimaonetsa Gleason kupititsa patsogolo kwa Gleason 4 + 3 = 7 mwa odwala awiri, kupita ku Gleason 4 + 4 = 8 mwa odwala 9 ndi Gleason 4 + 5 = 9 mwa wodwala mmodzi.
Mawu Ochokera
Cholinga chachiwiri chokhazikika, choyamba chakumapeto kwa zaka za m'ma 1980, chinali nthawi imodzi, njira yokhayo yodziwira khansa ya prostate yam'mbuyo. Komabe, tsopano tikudziŵa kuti chaka chilichonse amuna oposa 100,000 omwe ali ndi matenda okalamba 6 amayamba kupezeka mwachidziwitso. Izi zimayambitsa chithandizo chosafunika kwa amuna 50,000 pachaka. Mpaka titaphunzira momwe tingagwiritsire ntchito mawu otanthauzira omwe akuphatikizapo kalasi ya 6, chitetezo chabwino ndikuteteza kusokonezeka kwa singano 12 ya singano. Amuna omwe ali ndi mapepala apamwamba ayenera kulingalira kuchita mayeso a magazi a OPKO 4K. Ngati zotsatira za mayeso zikuwonetsa kuti chiopsezo cha matenda apamwamba ndi oposa 10 peresenti, MP-MRI pachigawo chapamwamba chikanakhala sitepe yotsatira yotsatira.
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