Nzvimbo yakatangira nzvimbo yeprostate gland , inenge mukati mamamilimita emukanda uye rectum, zvinoreva kuti urologist haingakwanisi kuderedza rutivi rwakapoteredza gland. Kusungira mumukaka kana kuti rectum hakusi kusarudzwa. Zvinosuruvarisa, kana kenza yemurwere inokura kuburikidza ne capsule, panzvimbo yekucheka nekenza, chiremba anovhima achabvumirwa kuderedza kenza panguva yekuedza kubvisa gland.
Apo izvi zvinoitika zvinonzi "marita akanaka."
Kusiya chirwere shure kwakakundikana kusagadzikana. Mushure mezvose, kana kenza isingagoni kubviswa zvachose, nei kuvhiya? Ichokwadi ndechokuti kusati kwatanga kushanda kune nguva dzose kusava nechokwadi nezvehuwandu hwekenza. Panguva yekushanda, chirwere chechidiki chinenge chiri kunze kweprostate hachionekwi neziso rakashama. Yeuka, ruzivo rwekuvhima kweprostate rwakagadzirwa munguva yekare apo dzose kanzira dzaionekwa sehupenyu hunotyisidzira uye kuvhiyiwa ndiyo ndiyo nzira yaivepo. Kare kumashure, teknolojia yehutachiona yakasarudzwa. Mishonga yaive yakanyanya kuderera nemayero uye marwadzo emigumisiro akanga akaipa.
Mafungiro emazuva ano ane 3T multi-parameter MRI yakaitwa vasati vasvika, asi vasina kukwana, vane mikana yekusimudzira chirongwa chokuvhiya zvikuru. Zvinosuruvarisa, vashomanana chete vevarume makumi manomwe vanosvika pakuberekwa gore negore vanobatsirwa nekuve nekutsvaga kwekugadzira chirongwa vasati vamboita basa.
Tariro, mutemo uyu uchachinja.
Pamusana pemamiriro ekutaura anotsanangurwa pamusoro apa, kenza, paavhareji, yasara mumutumbi wevarwere chero kupi zvako kubva 10 kusvika ku50 muzana yenguva. Chirwere chakasimba chinotanga kusvika kumurwere kwemazuva mashomanana mushure mekushanda. Mushure mokusunungurwa, prostate inotsvakurudzwa mu laboratori nedare rinodanwa rinonzi chiremba.
Iyo prostate yakagadzirirwa zvinyorwa zvinyorwa zvishoma kutanga nokuzviisa muhombodo yeki kuitira kuti yose yakasara yeglande yakavharwa. Zvadaro gland rinonongedzwa mukati mekunzvimbo dzakatetepa uye kunyatsotarirwa kubhadharwa kunzvimbo yeglandira iyo kenza iripo. Muongorori anonyanya kunyatsotarisa kumucheto weglandisi kuburikidza nekuushandisa pasi pekroscope. Kana bundu racho richicherechedza "kuputika" kunorwisana neinki, izvo zvinoreva kuti chirwere chechiremba chinoputika kuburikidza nechirwere panguva yekuvhiya, ichisiya tumorori shure mumuviri wemurwere.
Kuvapo kwemazamu akanaka kunogona kunge kwakanyanya kana kuderera zvichienderana nehuwandu hweGleason uye huwandu hwenzira dzakanaka. Pakati pebhodhi, muwandu wehutachiwana hwekenza yemangwana zvakare mune zvevarume vane margins akanaka kune 50%. Zvisinei, kana chikwata cheGleason chikapamhi kana kana mazamu akanaka akazara, dambudziko rekudzokerazve mune ramangwana rinogona kusvika zana muzana.
Kuwedzera Mushonga Kana Margins Achikwanisa
Kusarudza nezvekuwedzera kurapwa mushure mekuvhiyiwa apo mazamu akave akanaka angave akaoma. Imwe nzira ndeyokungocherechedza mamiriro ezvinhu apo uchitarisa mazinga ePSA pedyo. Iyi nzira inofadza apo chikamu cheGleason chiri pasi uye zvishoma nezvishoma zvakashata zviripo zviripo.
Varume avo vanoramba vari mukuregererwa vanogona kudzivisa maitiro anokonzerwa nemishonga kubva kumagetsi ose. Uyewo, munguva ino yekufambisa mberi kwekombiki, varume vanoenda kunonoka kurapwa kwemakore ekuwedzera kwePSA pasi pemugwagwa vanokwanisa kuva sekuru munguva yekuvandudza kurapwa iyo isinganyanyisi uye ine simba.
Kune varume vanosarudza kutevera kuongorora, PSA yekufanirwa inofanira kuitwa nekushandiswa kwekombiyuta. Zvadaro, kana PSA ikasimuka, kurapwa kunogona kutanga panotangira nguva, apo PSA ichiri pasi pe1. Mishonga yemitengo inonyanya kukosha apo kurapwa kunotanga pazinga rezasi rePSA.
Apo maitiro ekuvhiya ari akanaka, zvidzidzo zvakasiyana-siyana zvinoratidza kuti nokukurumidza mashizha kusvika kuprostate fossa inoderedza kuora kwemaitiro uye inogona kuwedzera zvishoma zvishoma makore gumi ekupona. Zvisinei, sezvo 50% chete yevarume vacharamba vachidzoka, kumirira uchapupu hwekusimudzira kwePSA musati watanga mazai angave mamwe maitiro anonzwisisika. Kazhinji, kuongorora kunosanganisira kuongorora PSA mwedzi mitatu. Radiation inotangwa kana PSA inokwira kumusoro kwe1 0.1 kana 0.2.
Mishonga inonyanya kurapwa kwekutungamirirwa kwekugara zvakare shure kwekuvhiyiwa. Kunyange zvazvo mazairo emagetsi anowanzobudirira, kunganganisa kwezvinhu zvinyoronyoro zvisingaiti kunze kweprostate fossa mune imwe nzvimbo yemuviri inoda kuonekwa. Mishonga ye fossa ndoga haizovi nekurapa kana chirwere ichi chapararira. Zvinosuruvarisa, chisarudzo chekupedzisira pamusoro pekuvapo kana kusavapo kwemasikirini emasikirini asingakwanisi kuve nechokwadi. Hapana teknikorasi inowanzoona zvirwere zvinyoronyoro ne 100 muzana zvakakwana.
Vadzidzisi vane ruzivo vakadzidza kuburikidza nekuziva kuti microscopic metastases inowanzovapo apo chikwata cheGleason chiripamusoro uye apo maitiro akanaka ekuvhiya ari akawandisa. Mune mamiriro ezvinhu aya, mashizha emisipiresi anofanira kunge akawedzerwa kuvhara lymph nodes. Hormone therapy naLupron inowanzokurudzirwa.
Akawanda Maitiro Akanaka
Kuongororwa kwekenza yeprotate pasina kunyatsokurapa hakuna kukodzera kune varume vane maitiro akawanda akanaka. Nzira dzakawanda dzinowanzoreva kuti kenza yepakutanga yaiva yakakura uye yepamusoro. Purogiramu yekuongororwa mumamiriro ezvinhu aya haina kukodzera nokuti kenza ine utsinye ichadzoka nguva dzose. Kuteerera kurapwa kunongobvumira nguva yakawanda yekenza kukura nekupararira.
Varume vane maitiro akawanda akatevera mushure mekuvhiyiwa vanofanira kutarisirwa nehutano hwehutano hwehutano hunosanganisira mahara, hormone therapy uye zvichida kunyange chemotherapy. Kunyanya, inguva yekuita nehasha, yekupedzisira yekuedza kurapa chirwere chacho. Pane misiyano yakakura pakati peongororo sezviri kuitika purogiramu inokurudzirwa. Zvisinei, kazhinji, zvirongwa zvekurapa zvinowanzofananidza nzira iyo yakanyanya ngozi, zvirwere zvitsva zvinotarirwa zvinotariswa (ona pasi apa). Mapurogiramu emapurisa ari kutarisa kuwedzerwa kwemasimba ane simba akawanda akadai seXtandi kana Zytiga kana kuwedzera kwe 4 kusvika ku 6 maitiro e chemotherapy ne Taxotere kuti aone kana chirwere chekurapa chinogona kuwedzerwa mberi.
Iyo pfungwa yakanaka kumirira mwedzi mishomanana mushure mekushanda musati watanga kurapwa. Izvi zvinopa imwe nguva yekuporesa uye zvinotarisira kubvumira kudzorerwa kwekugadzira urinary usati watanga kurapwa. Kuwedzerwa kunonoka, mune tariro yokuti erectile basa ichadzoka, chirongwa chingada kusvika kumakore maviri, kazhinji hachisi kungwara. Achifunga kuti pakanga pasina mararamiro asina kufanirwa, hormone therapy neLupron uye Casodex yakatangwa uye yakapfuurira kwemwedzi 12-18. Kubvunzurudzwa nemuongorori wemapurisa, uyo ane ruzivo rwekurapa mishonga yeplvic nodes, inowanikwawo.
Iyo inowanzopiwa mazano kune varume vane maitiro akawanda akanaka, ndeyokutanga tachidimbu yehutachiona iyo inotungamirirwa neprostate fossa uye lymph nodes. Node nhengo dzekudzivirira ndeyekutanga kukurumidza kubva pamucheto wekenza kana iri kupararira. Mazuva ano anotanga mazuva anenge 60 mushure mekutanga kweLupron neCodeodex. (Utachiona hweHormone hunobatanidza nehuwandu hwemigumisiro yechirwere, dzimwe dzingaderedzwa nemishonga, kudya uye kubhizimisa.) Ndinokurudzira varume vose vachifunga kuverenga nyaya yandakanyora panyaya iyi.
Mushure mekupera kwemaawa uye hormone therapy, kuramba uchiongororwa kunokosha. Testosterone uye PSA mazinga anoongororwa kwemwedzi mitatu kwemakore maviri, uye mwedzi mitanhatu kwemakore matatu anotevera. Testosterone yokutarisa inogona kumira kamwe kana maitiro evanhu achidzoka. Vose varume vane mazairo, kunyange avo vakaporeswa, vachada kurarama kwemakore ose nekuda kwehutano hwemakumbo ekudzivirira mahara emakumbo echikwata kana rectum. Kunyange zvazvo mhando idzi dzemakumbo zvisingawanzoitiki, kuonekwa kwekutanga kunotungamirira kune zvishoma-inotyisa, kurapa kwakanyanya.