Pandakanga ndichirovedza kuva muurosi muhu1980, chirwere chePSA chemvura chatinoshandisa pakuratidza kenza yeprostate chakanga chisati chavapo, uye kuwana chirwere cheprostate chaive chiitiko chechiitiko.
Vanachiremba vangave vakaitika pamusana pekunyunyuta pavanenge vachiongorora chirwere chemurairo wavo nechirongwa chepakati panguva yekuongorora (zvinonzi notorious digital rectal test ), kana kuti kuve nekuzivikanwa mushure mezviratidzo zvakagumisa munhu kuronga kusarudzwa kwechiremba kuti aone kuti chii chakaipa.
Hapana mamiriro ezvinhu akakodzera kubata kenza yeprostate mukutanga, iyo inonyanya kuraswa.
Makore makumi matatu adarika, hafu yezviitiko zvitsva zvinosanganisira kenza yeprotate yakanga yatotapararira kune dzimwe nhengo dzomuviri panguva yaionekwa. Kuvhiyiwa kwekenza yakawanda kunowanzoita sehuroyi huripo huri kubvisa mapepa evarwere-kuedza kurapa mapepa epamusoro nekuedza nenzara ye testosterone iyo mamota anoshandisa sehuni.
PSA Plates
Kuuya kwekuedzwa kwePSA muma1991 kwakatitendera kuita kufararira kwekenza yeprostate nenzira imwechete iyo yatinotarisa cheleesterool yakakura sechiratidzo chekutanga chechifo chemoyo. Mamiriyoni evanhu ave akaedzwa, uye zvigumisiro zvakatibatsira kuziva zvirwere zvinokuvadza zvinogona kubudirira kurapwa, sezvakaitika pane zvakaitika kuna Ben Stiller.
"Kuenzanisa" PSA kuedza pazera remakore makumi mashanu kunogona kuratidzira ngozi yehupenyu hwemunhu yekudzidzira kenza yeprostate uye kumubatsira iye nachiremba wake kuti vasarudze kuti kazhinji sei kudzokorora miedzo inofanira kuitwa.
Kana kuverenga kuri pasi pe 0.7 nanograms / milliliter (muwandu wevanhu vane makore makumi mashanu), upenyu hwehupenyu hwekenza yeprotate huri pasi pe10 muzana uye munguva yemberi PSA kuonekwa kungangodaro inongoda chete makore mashanu. Kana uwandu huri pasi pe2 nanograms / milliliter pazera remakore makumi matanhatu, mukana wekuwana kenza yehutachiona hwehupenyu kana kuuraya inenge inenge 2 kusvika ku3 muzana, uye kutevera-PSA kuedza kunogona kuderedzwa kana kubviswa.
PSA Minuses
Kunyange zvazvo kuongorora kwePSA kuchikosha, hazvina kukwana . Inoyera huwandu hweprotini inonzi prostate-specific antigen, kana PSA, inopararira muropa. PSAs inogadzirwa nemasero mu prostate gland. Kunyange zvazvo PSA yakakwirira ingave yakakonzerwa nekenza, nhamba dzinogonawo kukwidzwa nedzimwe zvirwere, zvakadai sezvirwere uye kuwedzera kwechirwere cheprostate chinoitika sezvinoita varume. Kunyange pakarepo, PSA huru inowedzera kubva pane imwe yero kusvika kune inotevera-chiyero chinonzi PSA velocity-hachisi chiratidzo chinotendwa pachako chekuvapo kwekenza yeprostate.
Mukuwedzera, hapana chakajeka-chakachekwa, pasi rose "chinowanzo" PSA level. Varume vazhinji vane marefu ePSA muropa ravo havaiti kenza yeprostate, asi vamwe vane maPSA ane maitiro akaderera. Pane humwewo uchapupu hwekuti PSA maitiro nemamwe maitiro ePSA akasiyana nevarume veAfrica -America kupfuura vakachena.
Somugumisiro wekusagadziriswa uku, vamwe varume vasingadi kupiwa biopsy yekuvhiya yeprostate yavo uye vanogona kuguma vachiwana kurapwa kwekenza iyo isingakoshi, asi vamwe varume vanoda kurapwa havakwanisi kuongororwa.
The Prediction Problem
Pakupedzisira, zviitiko zvePSA chete hazvikwanisi kufanotaura kozveramende yeprostate yeramangwana.
Mishonga yakawanda yeprostate inowedzera pangozi, inokura zvishoma, inokonzera vashomanana kana kwete zviratidzo, uye haifaniri kurapa. Zvimwe zvipembenene zviri kukurumidza kukura uye zvinogona kupararira zvakanyanya kune dzimwe nzvimbo dzomuviri. Zviri pachena kuti tinoda kuziva kuti ndeupi rudzi rwekenza murwere kuitira kuti tikwanise kuita mazano ekurapa akakodzera, asi maPSA maitiro haatibatsiri nekutonga ikoko.
A prostate biopsy , iyo inoparadzanisa zvipembenene kubva munzvimbo dzinoshungurudza yeongororo yekuongorora, inogona kubatsira kuisa maronda anenge ari pasi, ari pakati, kana kuti akaisa pangozi uchishandisa chikamu chinonzi Gleason chikwata, asi chinotenderera uye hachirevi nguva dzose kurwisa kwekenza.
Uye chinangwa chekuongorora kuongorora kwakanaka ndechekuderedza kudiwa kwezvinyorwa, sezvo zvisinganzwisisiki, zvinokonzera kushushikana uye zvinogona kuva nemigumisiro.
Nhau dzakanaka ndeyokuti kuongororwa kwekuongorora kuongorora uye zvimwe zvishandiso zvinoshandiswa zviri kuwanika, izvo zvinofanira kutibatsira ne "kenza / kwete kenza" uye "kukura-kukura / kurwisa" zvinogadziriswa. Ngatitarisei.
Kusvuta Kuongorora Kuedzwa
Kuongororwa kwakawanda kwekuongorora pamusika kwakaratidzwa kuva yakarurama kwazvo kudarika kuongorora kwePSA pakuona kuvapo kana kusavapo kwekenza yeprotate, uye pakuona huwandu hwehutano hwekenza hunofanira kurapwa. Dzinoshandiswa pamwe chete ne-kwete panzvimbo-PSA kuedza, uye inofanirwa kubatsira varwere navanachiremba vanosarudza kana bhiopsy inodiwa mushure mekuwedzera kwePSA mhinduro yekuedza.
Kuongorora ropa kana urini kunosanganisira 4Kscore ™ , Prostate Health Index, Mi-Prostate Score, uye ExoDx ® Prostate (IntelliScore). Chimwe nechimwe chinongororesa zvakasiyana-siyana, zvigadzirwa zvemhando yezvigadzirwa zvemhando , kana zviratidzo zvehupenyu, zvekenza. Vamwewo vanoyera PSA, asi nenzira dzakasiyana nedzidzo yekuyera. Somuenzaniso, muedzo (usingati wawanikwa mune zvekutengeserana) unonzi IsoPSA ™ yakagadzirwa naCleveland Clinic uye Cleveland Diagnostics, Inc., inotarisa kuchinja kwakasiyana-siyana mumapuraneti emapuroteni ePSA.
Kunyange zvazvo miedzo itsva yekuongorora ichi inoderedza zvirwere zvisingakoshi, kana Medicare kana vadzidzisi vasiri vega iye zvino vanozobhadhara pane zvavanoita (vamwe vatakuri vanogona kuzvifukidza mumisika dzomunharaunda) -kugadzirisa, zvichida, kubva pane zvavanotarisana nazvo kuti kuongorora kwePSA kwaive kuwanikwawo mahara echecheni echechikodhi asina kudikanwa kurapwa. Varwere vangatofanira kutakura mari, iyo inogona kuva mazana emadhora emadhora.
Iyi miedzo inobatsira mune zviitiko zvisinganzwisisi kana kuwedzera kwePSA chiratidzo chekenza, uye kune varwere vane PSA inokura uye yekare yakashata.
Nzira Yakanakisisa Nyaya Dzira
Kune varume vane migumisiro isina kukodzera kubva pane ipi zvayo yekuedzwa, danho rinotevera ibhiopsy. Mune nzira iyi tinotora sampuli yehutachiona hwechirwere chechirwere chekuongorora pane microscope kuti uone kana kenza iripo. Izvo zvave zvichangobva kuitika, kufambira mberi zvakanaka kuno, zvakare.
Kuti tiwane zvigunwe, tinokonzera mhando dzesinga (kubva pa12 kusvika ku24) kuzvikamu zvakasiyana zveglandu, inotungamirirwa ne-ultrasound scan. Takashandisa nzira iyi kubvira kuma1980. Iyo prostate idiki, inenge yakaenzana nehuni, mifananidzo yakawanda inobatsira kuti tiise nheyo zvakanaka. Asi mifananidzo haina kunyatsodonongodza zvakakwana kwatiri kuti titaure zvinganetseka, zvingangove nzvimbo dzine kenza kubva kune zvisikwa zvipenyu.
Ichokwadi ndechokuti tiri kushandisa nzira yekuparadzira, tichitarisira kuti, kana chiremara chiripo, chimwe chezvingano chichasangana nazvo. Izvi zvinokanganisa maitiro zvinogona kukanganisa zvirwere zvinokuvadza, nekuzarura zvimwe zvisingabviri uye zvingaguma zvichibatwa zvisina kufanira.
Nenzira inofadza, mhepo inonzi souped-up MRI inonzi multiparametric MRI inogona kusiyanisa pakati pechirwere uye chinonzi benign prostate tissue.
Zvingava zvakaoma kuita chidimbu apo murwere ari mukati meMRI scanner. Asi isu hatifaniri. Yepurogiramu itsva inotibvumira kuti tibatanidze, kana kuti fuse, iyo MRI yakawanda inongororwa yakawanda inotarisa nemararamiro ehupenyu, echokwadi-e-ultrasound kuti atungamirire nheyo dzebiopsy. Murwere anotanga kupinda MRI. A radiologist anoongorororodza uye anoratidza nzvimbo dzinonyunyuta. Gare gare, mune chirwere chekuvhiya chiri kunze, tinoisa svondo ye ultrasound mumutsara wemurwere, pedyo neprostate.
Iko fusion software inobatanidza MRI yakagara iripo uye inogara mifananidzo ye ultrasound. Sezvatinoendesa shanduro ye ultrasound kumativi ose eprostate, software inoshandura mufananidzo weMRI saizvozvo, ichipa mharidzo yakajeka, 3-D. Tinokwanisa kushandisa chifananidzo ichi chisingafananidzi kuti tibatanidze zvipfeko zvebiopsy kune chironda chatinoda kuongorora kunze kwekukomberedza uye tichivimba kuti tinowana chimwe chinhu. Zvakafanana nekushandisa GPS yako yefoni yekusvika kune imwe nzvimbo panzvimbo yekufambisa pasina mazano.
Dambudziko rine nzira iyi, inonzi MRI / transrectal ultrasound (TRUS) inoshandiswa fusion-guided, zvakare inodhura. Nhamba iyo inenge inenge $ 1,500 uye makambani einishuwarenzi haazobhadhari nokuda kwevarwere vari kuita biopsy yavo yokutanga. Vachazvivhara kana zvichishandiswa pakudzokorora nyanzvi kana kune varwere vakambotaridzirwa vane kenza yeprostate.
Nyaya inotungamirirwa-fusion haina kukwana. Chimwe chekudzidza chakawana kuti chinoshaya senge sezvipembenene zvakawanda zveprostate sezvinoita inonzi biopsy. Asi mishonga inorasikirwa ndiyo inonyanya kuve yakave yechipatara isinganyanyi kukosha iyo isingafaniri kurapwa. Uye fusion-guided guide biopsy zvakanaka kwazvo pakuona zvirwere zvinogona kutyisa.
Kufanotaura nezveAggressive Cancers
Kuti tibatsire kunyanya nekuongorora ikoko, kune mitsva mitsva inogona kuongorora tsvina yehupsy nokuda kwezviratidzo zvekenza yepamusoro. Aya maitiro e-genomic-Oncotype DX ® Genomic Prostate Score, Decipher ® Prostate Cancer Classifier, ProMark ® Proteomic Prognostic Test uye Prolaris ® kuedza-tsvaga kusagadzikana kweDNA iyo chiratidzo chekukura kwechisimba zvakanyanya.
Uyezve, maOcotype DX uye ProMark kuongorora zvinogona kufanotaura kana kune kenza yakawanda inogona kuvanza kune imwe nzvimbo mu prostate, munzvimbo dzaisati dzakapedzisira dziine nhengo dzesimbi. (Cleveland Clinic vakabatsira kuwedzera Oncotype DX uye vakabatanidzwa mukutsvakurudza kwakagadzirisa Decipher neProMark.)
Medicare uye mamwe makambani emishuwarisi anofukidza mari yezviongorori izvi zvinofanirwa nevarwere vane hutano hwehutano (yeGleason zvandakambotaura kare) zvinoratidza kuvapo kwezviremara zvakaderera-kana zvishoma. Vanowanzorega kubhadhara kuongororwa kunofanirwa mune zviitiko apo Gleason zvikwereti zvinoratidzira-kati kana kune ngozi yakawanda.
Nezviwero zvemajeri aya, vanachiremba nevarwere vanogona kuita zvisarudzo zvakanyatsozivikanwa pamusoro pekuita sei-kungave nekurapa kwakadai sekubviswa kweprostate, kana kushandiswa kwekutarisa, izvo zvinoreva nguva nenguva kuongororwa uye kuongororwa kwemaitiro emukenza.
Dr. Klein ndiye Sachigaro weCleveland Clinic's Glickman Urological & Kidney Institute, chirongwa cheNyika 2 urology yenyika sarudzo yakatarwa neU.S. News & World Report.
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