Chiyero chakakwana chekenza yeprostate inofanira kuona kenza yepamusoro yekodhenda yeprostate nenzira yakarurama apo ichidzivirira kuongororwa-chengetedza kwechirwere chisina kunaka, chepakati-grade (Gleason 6 dzakasiyana). Kudzoka muna 2011, US Preventative Services Task Force (USPSTF) yakakurudzira kupfuurira kuongororwa kwePSA mune varume vane hutano nekuda kwekupararira kwekurapa kwekenza yepamusana.
Dambudziko rakanga risati riri paruoko, mhinduro chete yavaizogona nayo ndeyokuderedza kuongorora PSA. Zvisinei, pamusoro pemakore mashanu ekupedzisira kubvira panguva iyi mazano ekutanga akaitwa, zvakave pachena kuti chikonzero chaiicho chekunyatsoongorora zvirwere ndezvisinganzwisisiki 12-nheyo yenzano yenyama , kwete PSA.
Zvinosuruvarisa kuti, chinonzi 12-core random biopsy inoenderera mberi kuva inowanzoenderana nevarume vane PSA yakakwirira. Zvisinei, teknolojia yakagadzirwa pfupi yapfuura inopa imwe nzira yekuita bhiopsy dzisina kuitika. Icho chinotarisa kuti kufungidzira ne-multi-parametric MRI (mp-MRI) inonyatsotsiva bhiopsy dzisina kuitika. Chinhu chikuru pamusoro pe-mp-MRI ndechekuti inonyatsoona kenza yepamusoro yekenza yeprostate kunze kwekufungisisa rudzi rusina ngozi rwekenza yeprostate (Bhuku 6). Zvimwe zvidzidzo zvitsva zvinoenderana nehurukuro iyi zvakapiwa musangano wekuAmerica Urology Association (AUA) we 2016 muSan Diego. Ichi chinyorwa chinoongorora zvidzidzo izvi zvinokosha, zvichiratidza kuti prostate kufungidzira munzvimbo dzepamusoro kushandisa MRI 3T yakasiyana-siyana inonyatsoratidza mhando yechikwereti yepamusoro uye inobatsira pamusoro pechirwere chinopararira.
The Studies Behind Prostate Cancer Diagnosis Test
Sezvo dambudziko guru rekuongorora kwePSA nderokuti inenge nguva dzose inotungamira zvakananga ku-12-core biomous biopsy, chidzidzo chekutanga chandingada kuchitaura chinopindirana nezvengozi dzingangodaro dzebasa rinopararira.
Abstract MP53-13 yakanyorwa naDkt. Alaina Garbens, akatarisa kuti varume vakagara sei muchipatara mushure mekunyorwa kwebhiopsy.
Akatarisa zvipatara zvekugamuchira zvipatara zvevanhu 61 910 vakawana bhaopsy dzisina kuitika muOntario, Canada pakati peJanuary 2006 naDecember 2013. Ichi chiongorori chakaongorora kufa kwehutachiwana uye chipatara chekugamuchira mahara mumazuva makumi matatu ekutanga mushure mekuberekwa kweprostate biopsy.
Vakawana kuti mukana wekufa kubva kune chibvumirano waiva umwe muzviuru gumi. Muyero wekugamuchira chipatara mukati memazuva makumi matatu ekutanga mushure mekushaya biopsy yaiva 3.5 muzana. Kubva iyo 3.5 muzana, vatatu-yechina yevarume vakabvumirwa kuti vabate chirwere. Sevhesi yechirongwa ichi, Dr Garbens zvakare akataura kuti nhamba yezviopsies iri kuitwa yakaderedza 30.6 muzana ichienzaniswa nehuwandu hwenyika dzakagadzirwa zvisati zvasarudzwa ne USPSTF.
Zvidzidzo zviviri zvekuwedzera zvakaiswa paAUA zvakatarisa mberi kuti mazano e USPSTF anokanganisa sei rudzi rwekenza inowanikwa. Zvose izvi zvidzidzo zvinoratidza kuwedzera kukuru kwekero rekenza kuongororwa kubva apo USPSTF yakapa mazano ekurega kuongorora.
Abstract MP39-04 naDr. Carl Olsson vakataura kuti mazano eUUSPSTF muna 2011 akabudiswa achirumbidza kuti vanachiremba vanorega PSA kuongorora-vamwe varume vari kuonekwa kuti vane mazinga epamusoro ekurapa:
Gore | Varume Gleason 8 kusvika ku10 |
2010 2011 | 14.8% 14.8% |
2013 | 19.7% |
2014 | 25.4% |
Zviri pachena kuti chiyero chevarume vanoonekwa kuti vane kenza yepamusoro yekenza yeprostate inowedzera kuwedzera.
Abstract PD09-03 yakanyorwa naDkt Glen Gejerman zvakare kuenzanisa kugoverwa kwechigarire kwemashure matsva akaongororwa mushure mekunge uye mushure memazano e USPSTF. Akaongorora varume vanosvika 2513 avo vakagadzirwa muna 2011 uye 1665 avo vakagadziriswa muna 2014. Chikwata chemuGleason chemapakati chakashanduka kubva kubva muna 6 muna 2011 kusvika muna 7 muna 2014. High Gleason scores (8-10) yakawanikwa mune 19 muzana ye 2014 biopsies maererano chete 9 muzana yezvinyorwa zvakaitwa zvakare muna 2011.
Idzo zvidzidzo zvekare zvinoratidza kuti mazano eSUFSTF okusiya PSA kuongorora ino kuderedza nhamba yevarume vari kuongorora PSA.
Mambure inokonzerwa nekuderedza kuongororwa kweGleason 6-chikwata chepamusoro chekenza yeprostate yevarume vanoita biopsy. Iyi ndiyo yakanga yakagadziriswa mazano e USPSTF. Apo USPSTF yakaita mazano avo zvakare mugore ra2011, pakanga pasina nzira yakasiyana yekuita 12-core random biopsy yekuongorora varume vane marefu ePSA. Saka kuderedza dambudziko rakakomba rekuongorora kuderedza zvirwere zvepasi, USPSTF yakaita chisarudzo chekuodza mwoyo PSA kuongorora zvachose.
Izvi zvinorevei: Uku kukurudzira kungave kwakanzwisisika zvakare muna 2011. Zvisinei, ikozvino kune teknolojia itsva iyo inopa nzira yakakosha yekuita bhiopsy dzisina kuitika.
Zvimwe zvinotevera zvidzidzo zvitanhatu zvakarongwa kubva mumusangano wekurota urology muna 2016 zvinoratidza kuti MRI yakasiyana-siyana inotevedzwa nechinangwa chinonzi chinonzi biopsy inonyatsoona kanhi yepamusoro yekenza yeprostate uye inovhara zvakanyanya dambudziko rekuongororesa chikoro chekutanga.
Abstract MP16-17 yakanyorwa na Dr. Yasukaza Nakanishi akaongorora kururamisira kwekuita biopsy yakananga yezvipembenene zvinoshungurudza zvakaonekwa ne 3T multi-parametric MRI (mp-MRI) yeprostate. Akafananidza migumisiro yekuita chinangwa chakakanganiswa nemigumisiro yakawanikwa nekuita 14-core random biopsy. Mukudzidza kwake, akaongorora varume makumi maviri nemaviri nepamusoro yePSA mazinga ane MRI-parametric (mp-MRI). Zvose zvinokonzera zvipembenene zvakaonekwa ne mp-MRI (PI-RADS-3 iri pamusoro) zvakarongwa. "Kanzera yepamusoro" yakarondedzerwa seGleason chikamu ≥4 + 3 kana kupfuura urefu hwekenza ≥5 mm. Vakaona kuti biopsy yakarongeka yakaonekwa 88 muzana yevarume vaiva nekenza huru uye 97 muzana yevarume vakange vane chirwere chaiva Gleason 8 kana kupfuura.
Abstract PD15-08 yakanyorwa na Drs. Peter Choyke naPeter Pinto vakarongedza zvikonzero zvinokonzera zvirwere zvepamusoro-grade zvinorasikirwa nehupopi inotarisirwa muna 1003 varume. Vakashuma kuti biopsy yakakanganwa yakarasika Gleason 7 chirwere mu 11 muzana yevarume uye yakashaya Gleason 8 kana yakakwirira mu2 muzana. Kudzokororazve kwep-MRI mifananidzo yevarwere ava vakaratidza kuti zvikamu zviviri kubva muzvitatu zvazvo zvaiva nechirwere chinoratidzika chakarasikirwa nachiremba achidudzira kuongorora. Munenge yose yezvasara, chiremba achiita nenyuchi bhiopsy akangorasikirwa neshungu. Iga 1 muzana yevarume vaiva neKRI chaiyo-isingaoneki kenza. Mune mamwe mazwi, kakawanda kukanganisa kwechirwere chakakonzerwa kuwana kenza kwaifanira kukonzerwa nekuverenga kweMRI kana kusarudzwa kunoratidzwa nachiremba achiita nenyuchi bhiopsy. Sezviri pachena, kufungidzira kunoshanda zvakanaka, asi murwere anoda kuziva kuti hazvizovimbwa kunze kwekuti inoshandiswa nounyanzvi navanachiremba vakadzidziswa uye vane ruzivo.
Abstract PD15-11 yakanyorwa naDkt. Amanda Lu yakarongedza zvakaipa zvisina kufanirwa zvinonzi mp-MRI kana zvichienzaniswa nesaropsy isina kuitika. "Kusagadzikana kunofanirwa kutarisirwa" kunoreva kuvepo kunenge kusina kenza kana iripo. Varume vane PSA yakakwirira vane mp-MRI haina kuratidza zvipembenene zvinorwadza zvakasangana ne12-core random biopsy. Kunze kwemashure makumi mashanu nevarume vane mp-MRI isingarangarirwi, asi 3.8 muzana chete vakawanikwa vachive nekenza yakave nechirwere chekenza (Gleason ≥7) yakasarudzwa sezvinotsanangurwa ne-12-core biopsy.
Abstract MP21-15 mutevedzeri naDkt. Jan Philipp Radtke vakafananidza nekuona kwakarurama kwe mp-MRI nekuvhiyiwa. Akaongorora varume zana makumi maviri nevatatu vakawana mp-MRI inotungamirirwa nekukanganiswa kwechirwere vasati vavhiyiwa. I-mp-MRI inocherechedza 110 (92 muzana) yezviremera zvakakura zvichienzaniswa nehutachiwana hutsva mushure mekuvhiyiwa. Pakati idzi, fusion biopsy yakaonekwa 80 muzana yezvikwiriso izvi zvepamusoro. Zvakare, izvi zvinoratidza kudikanwa kwekuita vanachiremba vane unyanzvi uye vane ruzivo kuti vaite chinangwa chakakosha.
Abstract MP53-02 yakanyorwa naDkt. Joseph Mahon akaongorora zvinyorwa zvevarume 395 vane PSA yakakwirira nokuda kwekuvapo kwekenza yekenza yeprotate. Vose varume ava vakanga vaine mp-MRI vasati vamboita biopsy. Varume vasina zviremera zvakakosha zvakaonekwa pa mp-MRI kana vane zvipembenene zvisingabatsiri vanofunga kuti havasi kenza (PI-RADS 1-2) vakaongororwa. Vane zana nemakumi matanhatu mapfumbamwe varume vakazadzisa izvi uye vakaiswa mukudzidza. Vose vakave nekusarudzwa kwema 12-core biopsy. Kakawanda, kenza yeprotate yakaonekwa muna 54 (32 muzana) varume avo 47 (88 muzana) vaiva Gleason 6 kana kuti uni-focus Gleason 3 + 4. Chirwere chinokosha, kureva, Gleason 4 + 3 chakaonekwa kuti mu10 muzana yevarume uye Gleason 4 + 4 yakaonekwa mu2 muzana. Mune mamwe mazwi, kuipa kunofanirwa kuitika kwechirevo chep-mp-MRI muchidzidzo ichi chaiva nezana nezana.
Abstract MP53-15 nheyo ne Drs. Peter Choyke naPeter Pinto vakaongorora kururamisa kwe mp-MRI fusion biopsy muchirongwa chezvikwata zvakasiyana-siyana. Varume vari muchidzidzo vakave nekutanga-mp-MRI yakateverwa nefusion biopsy iyo yakateverwa ne 12-core random biopsy. Mhando yekenza yeprotate yakagadziriswa yakanga yakabatanidzwa muzvikamu zvitatu: Kuderedza-panjodzi (Gleason 6 kana kuti pasi pasi Gleason 3 + 4 = 7), Intermediate-Risk (high volume Gleason 3 + 4 = 7), uye High-Risk (Gleason ye 4 + 3 kana kupfuura).
Zvose makumi mana nemakumi mana nemakumi matatu nemakumi mashanu evanhu vainzi biopsy-naive vakawanikwa kubva ku 4 masangano ekubatana. Fusion biopsy yakaongororwa zvimwe zvirwere zveHigh-Risk kupfuura 12-core biopsy (22.3% vs 20.3 muzana). Uyezve, fusion biopsy yakaonekwa 18 muzana mashoma matambudziko eGleason 6 (15.7 muzana ne19.2 muzana). Kusanganiswa kwehupfumi kunongorasikirwa nevarume vana vane Intermediate-Risk uye imwe neHigh-Risk iyo yakawanikwa nehupopoteri.
Zvinorevei izvi: Zvidzidzo zvitanhatu zvakapfuura zvinoratidza kuti mp-MRI inotungamirira fusion biopsy diagnoses high-grade yezvirwere zvishoma nezvimwe uye zvisingashandisi biopsy, kana zvisina kunaka. Asi kunyatsobatsirwa kwep-MRI pamusoro pehupenzi husina kunyanya kuwanikwa ndiko kunowanikwa kwepamusoro kwekenza yepamusana wechikwereti. Ihwo humwe hukomba hwe mp-MRI ndevamwe varume vanogona kukanganisa biopsy zvachose. Muvarume vanoda bhiopsy, vashoma biopsy cores inodiwa.
Chidzidzo chekupedzisira kubva pamusangano weAUA unobatsira pane ino nenyaya inosangana nemubvunzo wemari.
Abstract MP53-14 yakanyorwa naDr. Peter Choyke naPeter Pinto vanobva kuNational Cancer Institute muBethesda, vakatsvaga mari-yehutano hweprotate MRI kana ichinyanya kusarudzwa. Iko mari yevarume zana vanotarisana nemararamiro ($ 1,410 pamunhu) ndeye $ 141,035. Dhiyabhorosi dzisina kurongeka dzaizova zvisina kururama mumurume gumi nemaviri uye dzisina kunyengera varume 24.
Mutengo we mp-MRI we $ 633 uye MRI fusion biopsy ye $ 2 138. Zvose zvakakwana zvekuwana maitiro ekutanga eE prostate muvarume zana nevarwere chete vane chinangwa chechirwere (s) chinosangana nechinangwa chechiopsy, chakatsunga kuva $ 107,961.69 zvichipiwa kuti varume makumi manomwe vaizoita prostate MRI voga, uye varume makumi matatu vaizove nechinangwa chechiopsy. Pakati peboka revarume chete vari kuwanikwa ne prostate MRI, varume vanomwe vaizova nemigumisiro yakaipa uye 9 vaizove nemigumisiro yakanaka. Fusion yakakwana yehupopi inodhura 25 muzana zvishoma kudarika iri kuitika.
Izvi zvinorevei: Tsanangudzo pamusoro pehutano hweprostate kubva mumusangano wegore negore unoratidza kuti mamiriyoni 3T akawanda anogadzirisa zvakarurama anonyatsoratidza mhando yechikwereti yakakwirira. Zvakanakira pamusoro pezvinyorwa zvisinganzwisisiki zvakawanda: Chiitiko chepamusoro chekuongororwa neBanga 6, mari shoma, varume vashomanana vanoda biopsy uye zvinetso zvishomanana kubva pane zvinyorwa. Iyo chete yevhavha yekuchengetedza mupfungwa ndeyokuti yakagadzirwa zvakanaka mp-MRI inoda mamiriro ezvinhu ezvakanaka uye vanachiremba vane ruzivo, vakanyatsodzidziswa vanoverenga kuongorora. Saka, kusvikira unyanzvi hunova hwakawanda, iwe unogona kuenda kune imwe guta kuti uve nechokwadi kuti uri kuwana scan yako yakaitwa mukati mepamusoro.