Ndeipi chinhu chinotyisa pamusoro pekenza? Kune vakawanda, ndiwo mukana wekenza ingadzoka mushure mekuvhiyiwa. Iine kenza yakawanda yakawanda-kone, mazamu, uropi, melanoma , kana mapapu, somuenzaniso-izvi zvinodzokorora zvinenge zvese zvinouraya. Kenza yeprostate, zvisinei, yakasiyana. Iwe ungawana zvakaoma kutenda, asi varume vane chirwere chakadzoka zvakare vanowanzofa kubva paukweguru kudarika kubva mukenza yeprotate.
Kenza yeprostate yakasiyana
Sei kenza yekenza yekare ichisiyana zvakasiyana? Zvikonzero zvinoverengeka. Kutanga, inokura uye inopararira zvishoma nezvishoma kupfuura dzimwe mhando dzekenza. Chechipiri, mishonga iyo inactivate testosterone (hormonal blockade) inotyisa inoshanda. Varume vanoenda mukuregererwa kwemavhareji emakore gumi! Asi chinokonzera kenza yeprotate yakasiyana zvikuru ndeye rudzi rwepuroteni yakagadzirwa mu prostate gland inonzi prostate-specific antigen, zvichida inozivikanwa sePSA.
PSA Inoshamisa
Kunyange zvazvo kuenzanisa muwandu wePSA muropa rega kuti kuvharwe kwekenza kwave kwakabvunzwa zvakanyanya, PSA ndiyo yegoridhe yekutarisa zvirwere zvakare zvakare. Ichokwadi, mamwe mhando dzekenza haina chinhu chinoswedera pedyo nekururama kwePSA. PSA inoona kenza duku. Zvinosuruvarisa, dzimwe kenza zvinogona kuonekwa chete nemafungiro, mushure mokunge maronda anowanzove akareba zvakakwana kuti aonekwe neziso risina kusimba.
Kuti mishonga inoratidzike painotaridzika, inofanira kunge inopfuura hafu-inch inoupamhi uye iine masero anokwana mamiriyoni emukenza. PSA test test blood, kune rumwe rutivi, inoona kudzokorora zvakare sevashoma se100,000 masero.
PSA Nguva Yokudavira Ndeye Yakarurama Kupfuura Gleason Score
Kucherechedza kudzokorora nePSA pachikwata chekutanga kunogona kuunza mukana wekutarisa kuipa kwekudzoka zvakare.
Nekudzokorora, kuenzanisa kuenzanirana kwePSA-inoti neropa rega rega rinoswededza-chiyero chekuwedzera kwePSA chinogona kutsanangurwa zvakarurama. Kukurumidza zvakadini PSA kaviri inoratidzira chikoro chekudzoka zvakare. Idzi ruzivo rwakakosha zvikuru nokuti kudzoka kwegorosi rekare kunobatwa zvakasiyana zvakasiyana nekudzoka kwepamusoro-grade.
Vanhu vakawanda vanoziva neGleason grading system, nzira inonyanyozivikanwa yekenza kuisa muvanhu vachangobva kuongororwa , ndiko kuti, vasati vadzoka zvakare. Nehurongwa hweGleason, masero emukenza anochengetedzwa nechiremba chaiye anonzi chiremba. Muongorori wehutano anoona shanduro yebiopsy pasi pe microscope uye anopa chikero kune kenza . The Gleason system ndiyo chiratidzo chinonyanya kushandiswa pakutsvaga kenza yekare yekare uye ine basa rinokosha pakugadzirisa kurapa kwakakwana kune varume vachangobva kuongororwa. Zvisinei, mukenza yezve prostate yakadzokorora , nguva yePSA yokupeta kaviri inonyatsosimbisa kukodzera kwechikwata cheGleason. Zivo yekukura kwekenza ndiyo nzira yakanakisisa yekugadzirisa kushungurudzwa kwekenza, uye, nerufaro, PSA inogadzirisa izvi nenzira isina kufananidzwa.
Kana imwe nguva PSA yakapetwa nguva inoratidza kuoma kwekudzokazve, nzira yekurapa inoshandiswa.
Kurapa kunowirirana zvakasiyana zvichienderana nekirasi rezvezvekudzoka, saka nzira yakanakisisa yemishonga yega yega yega yekudzoka zvakare inokurukurwa pasi apa.
Low-Grade Relapse
Nokuda kwezvinotsanangurwa, zvikamu zvitatu zvakasiyana zvekudzoka zvakare zvinogona kurondedzerwa: pasi, mukati, uye kumusoro. Kuziva chikwata chekudzoka zvakare ndicho chikonzero chekusarudzwa kwekurapa. Vamwe vanodzokazve, somuenzaniso, vakaderera-gorosi zvokuti hapana kurapwa zvachose kuchadiwa. Izvi zvinoitika apo PSA inoda zvinopfuura gore kuti ivirire. Apo nguva yekubatanidzwa ichi inononoka, nzira yakanakisisa ndeyokuregeredza kurapwa uye kuramba uchicherechedza PSA mwedzi mitatu kusvika kumitanhatu.
Vakawanda vevarwere ava vanoramba vachirapwa nekusingaperi.
Intermediate-Grade Relapse
Apo varume vane PSA nguva dzinopetwa kaviri dzinenge dzichida, taura mumwedzi mitanhatu kusvika kumwedzi gumi nemaviri, dzinowanzove dzakabvumirwa kune imwe nzira yerapi. Nhoroondo yekare, kurapwa kwakagadzirwa nemapfumi akafuridzirwa emharaunda kunzvimbo yemuviri apo prostate yakanga iripo isati yabviswa. Nzvimbo iyo inotaridzwa inonzi prostate fossa. Dzimwe nguva magetsi anoshandiswa mumutambo uyu achava ekurapa. Zvidzidzo zvinoratidza kuti mushonga wehutachiwana hwakanakisisa kana mazairo akaiswa pamberi PSA isingasviki 0.5. Kufanana nemhando dzakawanda dzekenza yekurapa, kutanga kurapwa kwakatangwa zviri nani.
Hormonal Therapy
Kana mazai aya asina kubudirira, therain hormonal ndiyo mutsara unotevera wezvidziviriro. Nzira yakakurumbira ndeyekusarudza mujeri kubva kune rumwe ruzhinji rwemashandi anoshanda mahomoni anoshanda zvakanyanya kana akaenzana-Lupron, Trelstar, Eligard, Firmagon, kana Zoladex. Aya mishonga inokanganisa inowanzoshandiswa sekuchengetedza kana miviri isingakwanisi kudzora PSA inokura. Masero emukenza eprostate anoda testosterone kuti ararame, uye aya mishonga inoshanda nokuderedza testosterone. Kudzivirira kenza masero e testosterone inoita kuti vafe. Hormonal blockade inoita kuti anticancer inogadziriswe inogadziriswa inenge yakasarudzwa kwemakore gumi, ichifunga kuti kurapwa kwakatangwa kare, kureva, kusati kwasvika mapfupa emasitema. Nguva yehutano hwechirwere ndehupfupi zvikuru kana kenza yeprotate inobvumirwa kupfuurira mumapfupa musati watanga kurapwa.
Intermittent Therapy
Kuti kuderedze migumisiro yechirwere kubva kuva nechepasi che testosterone, nguva dzekurapwa kwenguva nenguva dzinowanzorudzirwa. Nzira inowanzoitwa ndeyokupa Lupron kwemwedzi mitanhatu kusvika kumasere uye wotora holide. Kazhinji PSA inodonha kusvika kudarika 0.1 mumwedzi mitanhatu yekutanga kurapa. Mushure mokunge mishonga ikamira uye migumisiro yayo inopera, testosterone inononoka zvakare uye PSA inotanga kubuda. Chipiri chechirongwa cheLupron chinotanga apo PSA inokwira kune imwe nzvimbo yakatarwa, taura pakati pevatatu nevatanhatu. Zvidzidzo zvinoratidza kuti nzira iyi inobatsira inodzora kenza pamwe chete uye kana Lupron inopiwa nguva dzose.
Mhanje Rudzi rweHormone Therapy
Dzimwe nguva zvinotyisa, maitiro emuromo ekurapa kwehomoni yakadai seCasodex (bicalutamide), kana pasina Avodart (dutesteride), inogona kuiswa panzvimbo yeLupron kuti iwedzere migumisiro. Iyi nzira yekutaura ingave yakasarudzwa, somuenzaniso, kune varwere vakura kana frailer. Zvipembenene zvinowanzoonekwa zvinowanikwa nehuwandu hunopindwa mujeri maitiro ehommonal-the tired, weakness, and gain gain-inowanzova isina kuoma. Zvisinei, kune imwe yechirwere chemaitiro inonyanya kufanana neCasodex-breast breast. Dambudziko iri, zvisinei, rinogona kupesana neine estrogen inogadzirisa piritsi inonzi Femara. Zvimwewo, muyero unonyoreswa wemasaisai unotungamirirwa kunzvimbo yemazamu vasati vasarudzwa neCodeodex kazhinji inodzivirira kuwedzera kwechifuva.
Kuchengetedza High-Grade Relapse
Varume vane kenza yezve prostate yekudzoka zvakare iyo PSA nguva yechipiri inenge isingapfuuri kwemwedzi mitanhatu inotarisana nemamiriro ezvinhu anotyisa. Kana chirwere chisina kuchengetedzwa nehutano hwakanaka, kenza inogona kupararira nekukurumidza uye inopisa upenyu. Pano, nzira yakanakisisa yekurapa ndeyekutora urongwa hutsinye hunovimba nekubatanidzwa kwezvipatara zvakapiwa panguva imwechete, aka nzira yakawanda yekuita. Zvasara zvechinyorwa ichi zvichataura nezvekurapa kwepamusoro-grade relapses.
State-of-the-Art Scans
Danho rokutanga nderokushandisa teknolojia yakananga yekutsvaga kuziva kuti mumuviri kanha iripo. Parizvino, iyo yakanakisisa inowanika lymph node inoongorora (lymph nodes inowanzova nzvimbo yekutanga yemasastases) iC 11 Acetate kana C 11 Choline PET inoongorora. Zvinosuruvarisa, muUnited States izvi zviongorori zviripo chete paPoenix Molecular kana kuMayo Clinic. Munguva pfupi yapfuura, rudzi rutsva rwePET scan runonzi Axumin rwakava rwakapararira zvikuru. Zvidzidzo zvakaenzanirana nekuenzanisira kwakakwana kweAxumin neC 11 PET iri kushandiswa. Imwe, mutsva wePET scan unonzi Gallium 68 PSMA ikozvino inopinda mumakiriniki ekuedzwa munzvimbo dzakasiyana-siyana dzakapoteredza US.
Mukuwedzera kune lymph nodes, kufambira mberi kenza yeprostate kunowanzopararira kumafupa. Kukosha kwezvikonzero zvakarurama kuti uone zvirwere zvepakutanga hazvigoni kunyanya kusimbiswa. Munguva pfupi yapfuura, teknolojia yepafoni inotarisa yakavandudzwa zvikuru nekushandiswa kwekambani itsva yeF 18 PET. Pose pazvinenge zvichibvira, F 18 PET bone scan inofanira kushandiswa panzvimbo yekare Technisium 99 nzira. PET kuongororwa nekenza yeprotate ndiyo yekuvandudza hutsva hunobudirira, zvichiita kuti vanachiremba vashandise mazaya ekurapa nenzira yakanyanyisa.
Radiation Plus Lupron Plus Casodex
Kana imwe nguva chirwere ichi chave chakagadziriswa nekunyatsoongorora, kutora nhamba yemasitasisipo haina zvishoma, (taura kwete kupfuura mashanu), danho rokutanga rokutanga kurapa naLupron plus Casodex neurongwa hwekuenderera mberi kwe gore. Kazhinji, mwedzi miviri mushure mokutanga Lupron, mashizha anochengetwa kune nzvimbo dzinozivikanwa dzemasastatic (izvo zvakaonekwa nekushambadza) pamwe nekuwedzera "mapofu" emishonga inonzi radiation kune prostate fossa uye ku "normal" lymph nodes. Iyi nharaunda yemuviri inorapwa nokuti ndiyo inowanikwa nzvimbo yakawanda yezvirwere zvishoma, uye kunyange mazuva ano PET inoongorora ingakundikana kuona kenza pano.
Zvirwere Zvinyorwa Zvinyorwa Kunze Kwemadiro Remiti
Zvidzidzo zvinoratidza zvakajeka kuti kana mashizha akaendeswa kunzvimbo dzinozivikanwa dzezvirwere, kupera kwekenza pane iyo nzvimbo kunowanikwa. Saka, kukanganisa kurapwa kunowanzobatana nehuwandu hwehutachiona husingaoneki mune dzimwe nzvimbo dzomuviri dzisingaoneki, pasinei nekanakisisa yekuwanika teknolojia yekuongorora. Nokudaro, paunenge uchitarisana nemhando idzi dzine ngozi dzekenza yeprostate dzine nguva dzinokurumidza kupetwa kaviri, kushandisa nzira ine utsinye iyo inoshandisa mishonga yemishonga ine basa rekuita muviri mukati momuviri wose unoita zvakakwana. Sezvakanga zvataurwa kare, chirwere chekare chinonyatsoshanda pakutanga kurapwa pane imwe nguva yapfuura, apo chirwere ichi chichiri chidiki.
Mishonga Yakawanda Yokugadzirisa Dambudziko Rakakura
Sezvo Lupron naCasodex vangave vari vatambi vakakodzera mumutambo wekurapa, vamwe vangashamisika kana mamwe maitiro emishonga inobatsira anticancer aripo. Apo mubvunzo wacho wakagadzirwa nenzira iyi, mishonga miviri inobva yasvika mupfungwa, Zytiga naXtandi. Aya masimba ane simba akaratidza kuti anticancer inoshanda kunyange kana achirapa varume vane kenza yakagadzirisa Lupron! Tichifunga kuti ivo vanonyatsotaurirwa nhengo dzomumuromo nehutachiona hwehunobudirira hunoitika, zvinonzwisisika kutora nzvimbo yeZytiga kana Xtandi yeCasodex.
Ko Zvakadini neKemotherapy?
Mukuwedzera pakushandisa kusanganiswa kwemishonga, sezvakange zvakaita nzira yakataurwa mundima yapfuura, nhoroondo dzinoratidza zvakare kuti kuwedzerwa kwemakemikari nemishonga inonzi Taxotere ine simba rekuvandudza kupona. Kunyange zvazvo kugadzirisa kwakadaro kusati kwaitika , zvidzidzo kuongororwa kusanganiswa kwe Taxotere neXtandi kana Zytiga zvinoratidza kuti nzira iyi inogona kuitika.
Mhedziso
Varume avo vane kenza yeprostate inodzokorora mushure mekuvhiyiwa haigoni kutora imwe-yakakura-inokodzera-yose nzira yekurapa. Apo nguva yePSA yokupeta inononoka, varume vanogona kutariswa zvakanaka. Apo nguva yePSA yokupeta inenge ichikurumidza, mazaya, Lupron, kana maviri acho anogona kubudirira kupedza kufambira mberi kwezvirwere kwemakore anopfuura gumi. Varume vane kurwisana kunorwadza kwakaratidzwa nenguva yakakurumidza yePSA yekupetwa kaviri vanofanira kunyatsofunga nezvekutanga kwekurapa kwemishonga yakawanda pamwe chete.
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