PSA kuyesa, kuphatikizapo cholesterol ndi mayesero ena, ndi chizoloŵezi chofala cha kuyezetsa magazi kumene kumachitika patsiku lachidziwitso la munthu. Koma kodi uyenera kuchita chiyani ngati PSA ili kunja kwa chiwerengero cha lipoti labu labwino? Ngati mufufuza kafukufuku wa ma labata, kufotokozera mayesero anu, mwinamwake munakumanapo ndi zolemba zina (onani m'munsimu) zomwe zimaperekedwa mu lipoti:
"PSAyi sayenera kutanthauzira ngati umboni weniweni wa kupezeka kwa matenda oopsa kapena osagwiritsidwa ntchito payekha ngati kuyesedwa koyezetsa khansa. Kugwirizana kwachipatala ndikofunikira.
Phula yowonjezera ya PSA ingangotanthauzira kukhalapo kwa khansara ya prostate mpaka biopsy ikuchitika. Mndandanda wa PSA ukhozanso kukwezedwa mu benign prostatic hyperplasia kapena zinthu zotupa za prostate. PSA kawirikawiri siikwera pamwamba pa amuna abwino kapena amuna omwe alibe odwala prostatic carcinoma. "
Verbiage wa mtundu woterewu akusonyeza kuti sitepe yotsatira idzakhala yovuta. Ndipotu, zikutanthawuza kuti chidziwitso chiri pafupi kutha. Nthano yochuluka ya prostate kuti iwonetse amuna omwe ali ndi PSA yapamwamba yakhala njira yoyendera golide kwa zaka 30. Mpaka posachedwapa, kutenga ma prostate angapo kuti ayambe kukuyezetsa ndi njira yokhayo yodziwira khansa ya prostate.
Ndondomeko Yopanda Njira Yopangidwira
Njira ya 12 yokhazikika ya singano yodaliratu yakhazikitsidwa bwino kwambiri ndipo ingathe kuchitidwa ndi urologist ku ofesi yake.
Mwamunayo ali pambali pake ndi miyendo yake yokwezedwa kumbali yake. Novocain amaloledwa kuzungulira prostate ndipo khumi ndi awiri, zazikulu zazikulu za singano zimachotsedwa ndi mfuti yodzaza kasupe pamtunda. Maantibayotiki amaperekedwa nthawi zonse pofuna kupewa matenda.
Ngati mwachita mwaluso, ndondomeko ya biopsy imatenga mphindi 10 mpaka 20.
Pambuyo pa ndondomekoyi, abambo amatha kutuluka magazi mumtsinje ndi masana kwa milungu ingapo. Mavuto osakhalitsa ndi zovuta zitha kuchitika. Ngakhale mankhwala opha tizilombo toyambitsa matenda, anthu ochepa (pafupifupi 2 peresenti) adzakhala ndi matenda akuluakulu okhudzana ndi kuchipatala. Zipangizo zomwe zimachotsedwa ku prostate zimatengedwa kuti zifufuzidwe ndi dokotala wodziwika bwino wotchedwa katswiri wa matenda a matenda. Zotsatira zimapezeka masiku awiri kapena atatu.
Kutanthauzira Lipoti la Mafupa
Dokotala yemwe akufufuza zitsanzo za chiopsezochi , yemwe akudwala matendawa, amafotokoza kukhalapo kwake kapena kusapezeka kwa khansa kuchokera kumtengowo. Pamene khansa ilipo, wodwala matendawa amafotokozanso kuchuluka kwa khansara (chiwerengero cha mankhwala omwe ali ndi khansara) ndi kalasi ya khansa. Kalasi ya kalasi ndi imodzi mwa zinthu zosokoneza kwambiri za kansa ya prostate.
Kumbuyo kwa zaka za m'ma 1960, Dr. Donald Gleason, yemwe ndi katswiri wodziwika bwino wa matenda a khansa, ananena kuti khalidwe la khansa ya prostate lidzakonzedweratu ndi ma makina a maso omwe amawoneka pansi pa microscope. Iye adayambitsa njira yolemba kuyambira 2 mpaka 10 yomwe idalosera kuti zingakhale bwanji kuti khansa ifalikire (kuchepetsa mphamvu). Mbali zake za Gleason scoring system zikugwiritsabe ntchito mpaka lero. Mbali zina za dongosolo zasinthika patapita nthawi.
Kusintha kwakukulu kwakhala kutulukira kuti Gleason zambiri 6 kapena zochepa sizoipa. Ngakhale kuti "maselo osadziwika" ali ndi maonekedwe ena a khansara, kafukufuku wa sayansi tsopano atsimikizira kuti Gleason 6 kapena zochepa sizingasokoneze. Maselo osadziwika omwe sagwiritsidwa ntchito mopitirira malire ayenera kusankhidwa kukhala matenda oopsa, osati khansa.
Makampani Ochipatala Akusintha
Tsoka ilo, kusintha kumachitika pang'onopang'ono ku zamankhwala. Pamene inu kapena wokondedwa wanu mumalandira lipoti la zovomerezeka za boma ndikuwona mawu adenocarcinoma, mwinamwake mungapeze izi kukhala zochititsa mantha kwambiri. Pafupifupi amodzi miliyoni amatha biopsy chaka chilichonse.
Mwa amuna miliyoni imodzi, oposa 100,000 a iwo adzapezeka ndi Gleason 6 (kapena m'munsi) adenocarcinoma.
Makampani a kansa ya prostate amayamba kusintha kusintha kwa kuzindikira kuti khansa yapamwamba 6 si kwenikweni khansa. Komabe, mu 2015, pafupifupi theka la amuna omwe anapezeka ndi a Grade 6 (50,000 amuna) anaikidwa pa kufufuza zochitika m'malo mochita opaleshoni yomweyo. Chifukwa chakuti amuna 50 peresenti amachitiridwa mankhwala oopsa, kuopseza kugonana ndi kuwonongeka kwa mkodzo (kusadziletsa) kuti asawonongeke, zikusonyeza kuti makampani azachipatala akufunika kusintha. Kodi kupweteka kotereku kungakhale kotani poyerekeza ndi zomwe tikudziŵa tsopano za khansa ya prostate 6 kapena yochepa?
Khansara Ndilo Mawu Achinayi
Madokotala akuyamba kusintha maganizo awo, koma zimatenga nthawi kusintha. Chimodzi mwa vuto ndikuti khansara ndi mawu anayi a kalata. Malemba ndi amphamvu, ngakhale atakhala owona. Mwachitsanzo, mawu akuti racist amapereka chithunzi chabwino. Mawu akuti "mafuko," kaya ndi mawu oyenerera kapena osatchulidwa, amamatira ngati guluu. Pamene anthu ambiri amadziletsa okha, guiltier iwo amawonekera.
Chinthu chinanso chokhalitsa chisinthiko ndichokuti makampani opanga khansara yaikulu, ochulukitsa mabiliyoni mabiliyoni ambiri apangidwa pazaka 40 zapitazo. Ndi kovuta kuti orologists asinthe njira zawo ndikupewa opaleshoni. Kutenga nthaŵi mu chipinda chogwiritsira ntchito ndi gawo lazokhazikika. Ndipo ndithudi, mpaka zaka 10 zapitazo, panalibe njira zina. Kuchita nkhanza kungakhale koyenera nthawi yomwe aliyense ankakhulupirira kuti khansa yonse ya prostate inali yoopsa. Thandizo loopsa kwambiri linali lofunika kwambiri padziko lonse lapansi.
Kusatsimikizika kwa Kuwunika
Chifukwa china chimene amuna omwe ali ndi khansa yapamwamba akuchitiranso chithandizo chosafunikira ndi opaleshoni ndi yakuti odwala ndi madokotala amalingalirabe kuti ndi njira yoluntha. Kafukufuku akuwonetsa kuti chiwerengero cha 12-biopsy sichimazindikira khansara yapamwamba ya kalasi (kalasi 7 mpaka 10) 25 peresenti ya nthawi! Kumbukirani, mazirawo amalowetsedwa mu prostate mwachisawawa , popanda kudziwa kuti chotupacho chili pati. Poganizira izi molakwika, pali mantha oyenera kuti khansara yapamwamba ikhoza kukhala yowoneka mosadziwika mu prostate. Nthawi zina amuna amasankha kuchita mankhwala "Kuti akhale otetezeka."
Anthu omwe amasankha kuyang'anitsitsa akhoza kukhala ndi prostate yawo zaka zingapo. Iwo sangadziwe, kuti madokotala awo amayesa kubwezeretsa kusagwirizana kwa chidziwitso chokhazikika mwa kubwereza mobwerezabwereza. Ngakhale izi sizikumveka bwino komanso zoopsa pang'ono, kufufuza kwa nthawi yaitali kumasonyeza kuti njirayi ndi yotetezeka bwino. Ambiri mwa amuna omwe ali ndi matenda apamwamba omwe sanafike poyambira amapezeka pa chiyambi choyambitsa matendawa omwe amapezeka mwachangu pamene khansara ili pa nthawi yoyenera kuti idzachiritsidwe.
Kujambula, Kuwongolera Osati Kukhalitsa Kwambiri
M'malo modutsa njira yosakhulupirika yopanda malire, odwala angapite ku malo abwino kwambiri a kupopera prostate ndi MRI yambiri. Manja odziwa ntchito pogwiritsa ntchito zipangizo zamakono, kansa yapamwamba ikhoza kutchulidwa molondola kwambiri kusiyana ndi zomwe zingapezeke ndi zochitika zapakati pa 12. Kuphatikiza apo, prostate MRI silingathe kupezeka kwa khansa ya m'kalasi 6 kapena pang'ono. Popeza kuti matenda a m'munsi aperewera "amasowa" ndi prostate MRI, amuna ambiri sagwidwa ndi matenda a khansa osafunikira.
Pali malo ochepa ojambula zithunzi padziko lonse, mwina 50 mpaka 100, omwe amajambula zithunzi za prostate molondola. Zida zofunika pa zotsatira zodalirika ndi:
- Zojambulajambula, scanner 3-Tesla Multi-Parametric MRI (mpMRI).
- Ophunzira a MRI omwe amaphunzitsidwa bwino momwe angachitire fanizo la prostate molondola
- Madokotala amaphunzitsidwa mosamala mukutanthauzira kujambula kwa prostate. Kupita patsogolo kwa kujambula kwa prostate kukuchitika mofulumira kwambiri moti ngakhale akatswiri ena a radiologist omwe amatsimikiziridwa ndi bolodi samadziwa zomwe zamakono zamakono angakwanitse.
Amuna omwe amajambula zithunzi za 3T mpMRI sasonyeza zilonda zokayikitsa akhoza kumangokhalira kumangokhalira kumangokhalira kutsata komanso mwina akutsatiridwa ndi zojambula zina ngati PSA yawo ikukwera. Ngati chotupa chokayikira chikawoneka, chowoneka chomwe chimagwiritsidwa ntchito pamagetsi ambiri kapena atatu akhoza kulunjika mwachindunji pa kusalongosoka.
Kutanthauzira Lipoti la MRI ya Prostate
Dokotala yemwe amawerenga sewero akufotokozera mwachidule zomwe zimachitika, zomwe zikugwera m'magulu atatu:
- Palibe umboni wa matenda apamwamba (chotero, palibe chofunikira cha chikhalidwe).
- Chilonda chokayikira chikupezeka. (Zomwe zimayesedwa ndizofunikira. Ngati matenda apamwamba akupezeka, kupitanso patsogolo ndi uphungu wokhudzana ndi chithandizo kumafunikira).
- Malo osokonezeka amapezeka. (Mwina biopsy yomwe ikukhudzidwa ikhoza kuganiziridwa kapena njira ina, kuyang'anitsitsa kwanthawi zonse ndi kupyolera kwa miyezi 6 mpaka 12 kungaganizidwe).
Nthawi kwa zilonda zamadzimadzi zoopsa
Kujambula "kumawona" zinthu zamtundu uliwonse kupatula khansara, kuphatikizapo minofu yambiri, malo otsekemera (prostatitis), ndi malo otchedwa prostatic hypertrophy (BPH). Zilonda zomwe zimakhudzidwa kwambiri ndizozikuluzikulu, zomwe zimapezeka m'madera ozungulira a prostate, zimayambitsa kapule, kapena zimagwirizanitsidwa ndi kuwonjezeka kwa magazi kapena kufalikira. Kachilombo kosayenerera kangapangitse chiwopsezo ngati zotsatira zotsatila zotsatila zikuwonetsa kukulitsa patsogolo. Zosankha zokhudzana ndi zovuta zowonongeka nthawi yomweyo kapena kupitiliza kufufuza ndi kufufuza nthawi zonse ziyenera kupangidwa pokambirana ndi wodwalayo ndi dokotala yemwe akumvetsa luso lamakono.
Siyani PSA Screening Palimodzi?
Mu 2011, chifukwa cha nkhawa zokhudzana ndi matendawa kuchokera ku kuyesa kwa PSA komanso kusokonezeka kwadzidzidzi komwe kumadzetsa zotsatira zoopsa kuchokera kuchipatala chosafunika, bungwe la US Preventative Services Task Force linalimbikitsa kuti asamawonetsedwe pafupipafupi PSA . Kafukufuku amasonyeza kuti madokotala ambiri oyambirira amatsatira malingaliro ameneŵa ndipo amasiya kufufuza kwathunthu. Koma Task Force ikusowa mfundoyi. Kuwonetsa PSA si vuto. Vuto likukulirakulira nthawi yomweyo PSA kukwera. Njira yowonongeka yomwe ikuyamba ndi kujambula kwa prostate ndikutsatiridwa ndi chidziwitso chodziwika ngati vuto lodziwika bwino lingathe kuthetsa vuto la mankhwala owonjezera.
Maganizo Otsiriza
Dziko la zachipatala likuyendetsa pang'onopang'ono kuti momwe chiwerengero cha 12 chachitsulo chosagwiritsira ntchito singano chimayambira ku matenda osadziwika a khansa ya Gleason-grade 6. Chaka chilichonse ku United States amuna 100,000 amapezeka kuti ali ndi "khansa" zopanda phindu. Mwatsoka, ambiri a iwo amadwala ma radiation kapena opaleshoni panjira iliyonse. Chinthu choyamba chofuna kusamalira bwino amuna omwe akuyang'aniridwa ndi PSA ayenera kukhala kufalikira kwa kufotokozera zapamwamba, m'malo mofulumira kuchita biopsy.
> Zotsatira:
> Eggener S, et al. Journal of Urology Vol. 185, P. 869, March 2011.
> Klotz L, et al. Journal of Clinical Oncology Vol. 28, P. 126, January 2010.
> Sakr W, et al. Journal of Urology Vol. 150, P. 379, 1993.
> Thompson, ndi al. New England Journal of Medicine Vol. 349, P. 215, July 2003.
> US Preventative Task Force. Kansa ya Prostate: Kuwunika. May 2012.
> Ndikufuna T, et al. New England Journal of Medicine Vol. 367, P. 203, July 2012.