Kushanda Kuongororwa, Kuvhiya, kana Kuti Mvura? Zvinodzidziswa Nezvidzidzo
Nokuda kwekushayikwa kwezvidzidzo zvakaenzaniswa zvakanaka, kurapa kwekenza yeprotate kwave kwakakakavadzana zvikuru. Zvisinei, muna Gumiguru 2016, nhau mbiri dzinonyanya kushandiswa dzakabudiswa muNew England Journal of Medicine dzinoparidzirwa makore gumi kubva kune 1 643 vakazvipira vakazvibvumira kuti varambe vaine mazita (maererano ne "kutora michero") kurapa pamwe nekuvhiyiwa, kupiswa kwezuva kana kushanda surveillance.
Chidzidzo chekutanga chakafananidza nemakore gumi ekubuda, apo wechipiri, shamwari yekudzidza, akashandisa mibvunzo yekuenzanisira kuenzanisa mararamiro ehupenyu. Chokutanga, tichakurukura mubvunzo wekupona. Ipapo tichataura nezvehupenyu hwehupenyu hunoita.
Kukosha Kwokudzidza Chigadzirwa
Kuwana vanozvipira kuti vatore chikamu munharaunda dzakapiwa kurapwa, pane kusarudza kurapwa ivo pachavo, zvakaoma kuita. Hazvishamisi kuti iyi ndiyo chete yongororo yakambobudiswa yerudzi urwu. Kunyange zvakadaro, kurasika kwakakosha kuve nechokwadi chokuti varwere mune rimwe nerimwe mapoka matatu avo vane hutano hwakanaka uye vane imwe yakafanana yekenza yeprostate. Pasina chivimbiso chehupakati pakati pemapoka, zvidzidzo zvingave zvisina kuvimbika.
Kuzvienzanisa Iwe pachako kuChidzidzo
Kunyanya kukosha kwekutsvakurudza kwakarongeka ndechokuti kanangwana vaongororwa nekenza varwere vanogona kuwana ruzivo rwakarurama pamusoro pekuti nzira nhatu dzinoshandiswa pakurapa dzinofananidzwa sei.
Zvisinei, kuenzanisa zvakajeka, nhoroondo yemurwere inofanirwa kunge yakafanana nevarwere vakapinda muchidzidzo. Saka, regai tiongorore ruzivo rwevadzidzi vanenge vachidzidza. Makore avo kubva pa50 kusvika ku69, uye avhareji yemakore vari 62. Avhareji PSA aiva 4.6. Mune chikamu chechina chevarume, chiremba aigona kunzwa chirungu cheprostate nemunwe wake.
Vane gumi pavatatu vevarume vaiva nePSA zvishoma pasi pegumi (kunyange zvazvo paiva nevarwere vashomanana vane PSA mizinga iri pakati pe10 ne20). Zvitatu zvechina zvevarume ava vaiva Gleason 3 + 3 = 6., chimwe chechishanu chaiva naGleason 7, uye mumwe chete kubva kune makumi mashanu yevarume aiva neGleason mazana 8 kusvika ku10.
Kuongorora nekushanda kwekushanda
Kuongorora chero chii chinonzi "kenza" kunogara zvakanaka nevarwere uye vanachiremba zvakafanana. Icho chirevo chisina kunaka uye nzira iyo ichiri kuchinja. Nzira yekutsvakurudza iri muchidzidzo yakabatana zvikuru nePSA chete . Kushandiswa kwekutevera-biopsies kana kufungidzira ne-multiparametric MRI haina kukurudzirwa izvo zvisingashamisi nemazuva ano. Pamakore gumi ekudzidza, inenge hafu yevarume vari muboka rekucherechedza raive nekuvhiyiwa kana kupiswa kwemhepo kunenge kusina kujairika. Pfungwa yepamusoro inotarisa kuongorora ndeyekutarisa varume zvakanyanya, uye kana kenza inokura, shandisa kurapa usati wagadziriswa nekenza.
The Impact Treatment on Survival
Iko huru yekugadzirwa kwekudzidza kwaiva kupindura mubvunzo umwe- kupona. Apo vanhu vanotanga kunzwa kuti vane kenza, vazhinji vanopedzwa nemafungiro ekuti vangadzivisa sei kufa kwekutanga. Kana kupona ndiko kunonyanya kukosha, chidzidzo ichi chinonyatsotaura kuti nzira yekurapa haigadziri kusiyana .
Mumapoka ose matatu, chigumisiro chacho chaiva chakafanana. Iga 1 muzana yevarume (inenge yevarume 17) yakafa nekenza yeprostate mukati memakore gumi ekutanga. Iyi nhamba yakaderera kana tikafunga kuti chii chaizoitika kana varume vane Gleason 7 uye / kana kuti chironga chinoputika chisina kubviswa pachidzidzo. Mumakore gumi ekutanga, pakanga pane kufa kwevatanhatu bedzi kune varume vane Gleason 6 uye kuongorora kwemazuva ose (varume vatanhatu vakanga vakaparadzaniswa zvakafanana mumapoka matatu). Izvo zvinoshandiswa pakurapa pamusoro pekufa, kunyanya munguva yemakore gumi ekutanga, zvinoratidzika zvisina maturo.
Ko Zvakadini Nemasitasase?
Asi zvakadini pashure pemakore gumi?
Uyu hausi wepamusoro-soro mubvunzo mukuru kune varume vari kusundira makumi manomwe; varume vari mumakore makumi mapfumbamwe nemasere vanowanzofa nekuda kwezvikonzero zvisingaiti. Asi chokwadi mubvunzo unobatsira kune varume vari mumakore avo makumi mashanu. Chidzidzo chacho chinorondedzera dambudziko risinganyanyi kuwedzera rekugadzirisa zviratidzo zveboka revarume vaive vachienzanisa nekuenzaniswa nekuvhiyiwa nekukurumidza kana kupisa. Kunyanya, varume 29 bedzi, 13 avo vakavhiyiwa uye 16 avo vaiva nemirairo, vairarama nemasitasisita mushure memakore gumi; asi varume makumi maviri makumi maviri nemakumi matatu pakuongorora vakave nemagetsi . Izvi zvinotarisa kunze kwehuwandu hwehutatu hwepakati pehutatu hwemastastasine nekuongororwa nekuenzaniswa nekuvhiyiwa kwekurumidza kana kupisa. Haisi musiyano mukuru, asi zvechokwadi zvakakosha kana iwe uri mumwe wevarume vasina unlucky mu3%.
The Impact of Metastases on Survival
Sezvo vanenge makumi mashanu kubva muzana yevarume vanovaka metastases vachapedzisira vachifa nekenza yeprostate, inoratidzika, maererano nekudzidza uku, kuti varume avo vanorapwa vachishanda zvakajeka vachave nechepamusoro pekufa kwevanhu (zvichida 1 kusvika 2 muzana kumusoro) iyo ichaita inoitika kubva pamakore gumi kusvika pamakumi maviri mushure mekunge uongororwa, uchienzaniswa nevarume vanoenda kuvhiyiwa kana kuti mahara. Zvisinei, ichi chinofanirwa kutorwa nehura huru yemunyu, tichifunga kuti nzira dzekutarisa dzinoshandiswa dzakanga dzisina kukwana nemazuva ano. Sezvakataurwa pamusoro apa, varume vacho vakangotariswa nePSA. Vakanga vasina kuverenga nguva dzose neMRI multiparametric , uyewo kwakanga kusina maitiro ekuongorora maitiro akashandiswa panguva yakarongwa. Ava varwere vakasiyiwa zvakanaka chaizvo kuti vadzivirire ivo pachavo. Tichifunga nezvehutano hunoshamisa hwekuregererwa, huwandu hwemastasimasi huwandu hwe3% chete chaizvo hunoratidzika kunge hwakadzika.
Kuongororwa Kwekombiyuta Kwakagadziridzwa Kunoshamisa
Pane chimwe chikonzero chinokurudzira kuti tifunge kuti iyo yakakwirira yemetastasis yakataurwa munyaya ino inofungidzira dambudziko rekushanda. Nhoroondo yevarume vakabvumirwa kupinda muchidzidzo ichi haisi yomufaro wemhando yevarume avo vanowanzokurudzirwa kuti vaongorore. Inopfuura chikamu chechina chevarume vari muchidzidzo ichi chaiva neGleason zvidzidzo zvinomwe kana kupfuura, chironga chinoputika chinowanikwa padijitori rekuongorora kweprostate yavo, kana maviri. Uyu ndiwo rudzi rwakanyanya hutsinye hwepurogiramu yekenza kupfuura iyo inowanzokurudzirwa kuongororwa.
Kuvandudza Kwemagetsi Nekuvhiya kana Miridzo?
Tisati tasiya hurukuro yedu yekurarama uye tichienderera mberi kune kukurukurirana kwehutano hwehupenyu, ndine humwe humwe humwe hunotarirwa kupa. Ndakatsoropodza nzira yekudzidza kuburikidza nokuvimba nePSA kutarisa chete sekusakwanira. Asi zvakadini nehutano hwekuvhiya kana kupiswa kwemhepo? Tingatarisira chirwere chakakwirira chekushandisa shanduro ye 2016 kana ichienzaniswa neiyo varume vari muchidzidzo ichi vakagamuchira? Mhinduro shoma ndeye. Kunyange zvazvo zvidzidzo zvekuvhiya kwebhobhoti zvinoshuma nekukurumidza kuporesa, kurapwa kwehuwandu uye huwandu hwehupombwe nehutano hwekugadzirisa hazvina kubudirira. Nezvekunze kwemazhenje emvura, zvirwere zvehutano nemigumisiro nemagariro emazuva ano anowanikwa munzvimbo imwe chete.
Unhu hweHupenyu Nezvezvinhu Kana Kupona Kwakafanana
Kutsvaga kwekushanda kwakarongeka kunonzwisisika chete kana zvichishandurwa kuburikidza nehuhu hwehupenyu hunoona. Chikonzero chega chega chekurega kurapwa ndiko kunetseka kwakagadzikana kwakagadzikana kwekuti basa repabonde nehutano hune hutano huchaoma. Kana kurapwa kwaisava nemigumisiro, munhu wose aigona kurapwa; varume vanogona kufamba nehupenyu hwavo uye vanokanganwa pamusoro pekuongorora kunze kweperiodic PSA check. Zvisinei, ngatishandise zvinetso zvinowanzobatwa nehutano, pangozi yekushaya simba uye kusava nehanya.
Mibvunzo Inonzi Before and After Treatment
Mune shamwari yekudzidza kuongorora hutano hwehupenyu, vose vatori vechikamu vakabvunzwa nezvebasa ravo repabonde nekugadzirisa urani vasati vatapwa, 6 nemwedzi 12 mushure mekurapa, uye gore negore pashure pacho. Mukuenzanisira iyi, kuvhiyiwa kwakaonekwa nyore nyore sechisarudzo chakaipisisa kubva pamamiriro ehupenyu. Pasati kurapwa, 1 muzana chete yevarume vakanga vane urinary incontinence uye vaida mapeji ekudzivirira. Asi iyo yakawedzera kusvika 46 muzana mwedzi mitanhatu mushure mekuvhiyiwa uye zvishoma nezvishoma yakapfuurira kusvika 17 muzana makore matanhatu gare gare. Makore matanhatu shure kwemazivi kune rumwe rutivi, 4 chete yezana yevarume vaida padhi. Zvikamu gumi nemasere zvevarume pavanotarisa vaida padhi (yeuka kuti vanhu vanenge makumi mashanu kubva kuzana muzana pavanenge vachitsvaga vakashandurwa vakanonoka kuvhiyiwa kana kupiswa kwezuva).
The Impact Treatment on Sexual Function
Ndinofunga kuti nzira yakanakisisa yekukurukura zvitsvakurudzo zvekudzidza pamusoro pebonde / zvakakosha ndeyokukupa purogiramu yakananga kubva pakudzidza:
"Pakuvamba kwekutanga, 67 muzana yevarume vakataura zvinyorwa zvakasimba zvakakwana nokuda kwepabonde asi nemwedzi mitanhatu yakawira kusvika ku 52 muzana mubato rinoshingaira-kutarisa, kusvika ku22 muzana mumagetsi ekudzivirira uye kusvika 12 muzana muboka rekuvhiya. Erectile basa yakaramba ichingowedzera muboka rekuvhiya nguva dzose, uye kunyange zvazvo paive nekuwanazve 21 muzana pamakore matatu, chiyero ichi chakasarazve kusvika ku17 muzana pamakore matanhatu. Muyero wemakore matanhatu ekutsvaga kwemazuva ano waiva 27 muzana. Chiyero chemukati chekuongorora boka raiva 41 muzana pamakore matatu ne30 muzana mugore 6. "
Nepo pachave nekudziviswa kusingadzivisiki mune zvepabonde pane nguva muvarume ava vakwegura, zvigumisiro zvichiri kuratidza kuti kuvhiyiwa kune chinetso chakanyanya kudarika chinonzi radiation kana kushandiswa kushanda. Sezvakataurwa mubhuku racho, chetatu chevarume vari muzera iri vatove vasina simba vasati vapora. Sezvo varume vekare vasina simba vasingakwanisi kuve vasina simba nemishonga, uye zvimwe zvipingamupinyi zvakakomba zvakanga zvisingawanzoitiki, zvinoratidzika kuva nechishuvo chikuru chekudzivirira mashizha mukati meboka revarume vane preexisting impotence.
Mhedziso kubva kune idzi Two Landmark Studies
Chokutanga, kuponeswa kwemazinga nekushandura kwakarongeka kwakaenzana nekuvhiyiwa pakarepo kana kupisa kwemvura kusvika makore gumi. Kuchengetedza kuchengetedzwa nekuchengetedzwa kwehuwandu kupfuura makore gumi, varume vanofunga nezvekuchengetedza kushanda vanofanira kuisa kunze kwekupi kwechirwere cheGleason chikwata che7 kana kupfuura pamusoro peMRI yakawanda yepamusoro pakatarisana nenyaya yakatarwa gore negore. Chechipiri, kuponeswa kwemazinga nemirasi yakafanana nekuvhiyiwa asi nehuwandu hwekuvhiringidza uye zvepabonde. Kunze kwezvido zvaro zvepabonde, kupisa kwezuva kunonyatsotenderwa. Kana kurapwa kuchionekwa sekudikanwa, mazairo inzira yakanakisisa yekurapa kenza yeprotate kupfuura kuvhiyiwa.