Sezvo pane zvikamu zvitatu zvakasiyana-siyana zvinokonzerwa nekenza yenguva refu yekenza-yeka, chirwere chepakati uye chepamusoro-soro chinoshanduka. Nenzira yakawanda, nzira yedu ndeyekukurudzira kushingaira kuongororwa kune varwere vane pangozi, mbeu inowanikwa kune varume vane chirwere chepakati-panjodzi, uye mbeu inogadziriswa pamwe nekuwedzerwa kwechirwere kune varume vari munzvimbo yakanyanya ngozi . Izvi zvisarudzo zvakauya maererano nekutsvakurudza kwakaenzanisa migumisiro pakati pemishonga yakasiyana-siyana.
Kuvhiya kana Bhizimusi Radiation?
Zvisinei, nyanzvi dzakawanda dzinopesana. Nenzira, maitiro maviri chete ekurapa kwekurapa, kuvhiyiwa kana kupiswa kwechiedza, inoratidzwa nevarapiki uye maharareti maharapa, vanachiremba vanowanzobata varume vane kenza yeprostate. Kutarisa kushanda kana mbeu inonzi radioactive, inonziwo brachytherapy, inowanzosiyiwa kunze kwekukurukurirana.
Kwemakore, chinangwa chave chave chiri pamakakatanwa pakati pekuvhiyiwa uye kupiswa kwemhepo, mubvunzo uri, "Icho chisarudzo chimwe chete zviri nani here?" Uye ne "zviri nani", tinoreve kuti: kurapwa kupi kune mishonga yepamusoro yehutano uye inonyanya kukoshesa urinary uye zvepabonde basa?
Yakave yakambofungidzirwa kuti kuvhiyiwa uye kupiswa kwezuva kune zvimwe zvakafanana, asi unhu hwekuenzanisa nesayenzi hunoona kana imwe iri nani pane imwe yakashaya. Nokudaro, varwere uye vanachiremba zvakafanana vakatsigira pamanzwiro evanhu uye maonero avo pachavo pamusoro pekudzidziswa, kunyatsogadzirisa kuita sarudzo.
Zvisinei, varume vari kutsvaga mhinduro vari kukomborerwa nekukura kwechimwe chinhu chitsva-kubudiswa kwe musoro-ku-musoro, kuongororwa kwekliniki yekuenzanisira kuenzanirana nekuvhiyiwa, kupiswa kwezuva, nekushongedzwa kushanda.
Miedzo yeRandomized inokosha nokuti inopindura mubvunzo wakananga kubudirira, kusimbisa kubviswa kwezvinyengeri, dambudziko rinopararira nekudzoka kwezvidzidzo (kupfuura makumi mapfumbamwe nemapfumbamwe muzana yemuedzo kuenzanisa kuvhiyiwa uye kupiswa kwemazuva kunowedzera).
Chikonzero chekuti pane vashomanana vanotarisira miedzo ndeyokuti vatsvakurudzi vanofanira kuwana varwere vanoda kuzorapwa maitiro avo. Muchiitiko chakakurukurwa pasi apa, varume vacho vaifanira "kutora tsvina" nenzira yekufananidzira kuti vaone kuti ndiani aizovhiyiwa, kupiswa kwemhepo kana kuongororwa mune imwe nzira inonzi "randomization."
Zvidzidzo zvakasiyana-siyana zvekudzoka zvakare zvatovapo, kuedza kuenzanisa migumisiro yemirairo uye chirwere. Vakasvibiswa, zvisinei, nematambudziko mazhinji anokonzera, muenzaniso umwe uri wekusaenzana kwezera revarwere. Kazhinji, varume vaduku vanopiwa kuvhiyiwa uye varume vakwegura vanorapwa nemirairo.
Kufananidza kwakafanana neizvi hakuna kusaruramisira nekuti zvinonyatsozivikanwa kuti varume vaduku vane migumisiro iri nani pasinei nokuti rudzi rwekurapa runoshandiswa sei. Kusvikira ikozvino, sezvo chete "dhiyabhorosi dhesi" yakave yakashandurwa nedzidzo yakabva kune vasina kukodzera mapoka, vanachiremba vave vakasununguka kusarudza chero zvidzidzo zvekudzoka zvinotsigira hukama hwavo pachavo kudzivirira nzvimbo iyo imwe kurapa inokunda imwe.
Active Monitoring
Saka nei pasina kumbove nedzimwe nhepfenyuro yekutsanangurira kuenzaniswa, mazairo, uye kushandiswa kwekutarisa? Chokutanga, miedzo yakadaro inodhura zvikuru. Mazana evarume vanoda kuongororwa kwemakore anopfuura gumi.
Chechipiri, zvakaoma kuwana varume vanofarira kutora tsvina yekutsvaga kurapwa. Chechitatu, sezvo miedzo inotora nguva yakareba kuti ikure, kuronga chiyero chakadai kunoda kuonekwa kwakanaka kuti kuve nechokwadi chokuti mubvunzo unopindurwa nemhosva ichave yakakosha makore gumi nemashanu munguva yemberi.
Sezvakaoma seyonguva yakareba, vanotarisira miedzo ndeyekubhadhara nekuita, ivo vanoda chaizvo. Kushayikwa kwemiedzo ye randomized nguva dzose nguva dzose kunokonzera kukakavara uye kusagadzikana. Pasina ruzivo rwakananga, kusarudzwa kwekurapa kunoguma kunotungamirirwa zvikuru nemari yekufungisisa -kurapwa kunobhadhara zvakanakisisa kunowanzozivikanwa zvikuru.
Saka shanduro ichangobva kuwanda yezvidzidzo zvakasiyana-siyana zvisinganzwisisiki zvakananga kuenzanirana nemigumisiro yekurapa kwekuvhiyiwa, mahara, uye kushandiswa kwekushanda ndezvechokwadi. Idzi zviitiko zvinoshamisa zvinoita kuti isu pakupedzisira tizive pasi rechokwadi.
MunaSeptember 2016, New England Journal yeMishonga yakabudisa nyaya yakanzi "Zvinokwana makore gumi pashure pekuongorora, kuvhiya, kana kuti Radiotherapy ye Localized Prostate Cancer". Muchiitiko ichi, varume mazana mapfumbamwe nemazana matanhatu (1650) vakashandiswa kuongororwa, kuvhiyiwa, kana kupiswa kwemhepo, uye kutevererwa kwemakore gumi. Mhando yevarume vakapinda mukutongwa kwaive yakafanana nemunhu akawandisa uyo anonzi ane chirwere chekutanga-chechi kuburikidza nePSA kuongorora . Nguva yavo yepakati yaiva 62. MuPSA wepakati aiva 4.8.
Zvitatu zvechina zvevarume izvi hazvina kunzwisisika pa digital digate yekuongorora uye chechina chechina chakanga chisina kukwana. Zvishoma pane zvitatu zvechina zvevarume vaiva Gleason mapfumbamwe. Chimwe chechishanu chevarume vaiva Gleason chikamu 7 uye mumwe chete kunze kwevarume makumi mana aiva nechikwata chepamusoro cheGleason, chepfumbamwe kusvika kune gumi.
Mushure mokunge vabvumirana kuti vatore chikamu muchidzidzo chacho , varume vakagoverwa kushanda nokukurumidza, pakarepo masayiti kana kushandiswa kushanda. Avo avo vakanzi vaongororwe vaive nechirwere chavo chichiongororwa nguva dzose kuitira kuti kurapwa kunogona kutangwa sezvakakodzera.
Pamusoro pemakore gumi anotevera ekucherechedza, inenge hafu yevarume vekuchengetedzwa yakazoperevedzwa kurapwa nekuvhiyiwa kana kupiswa kwemhepo. Zvinofadza kuti vazhinji vevarume vari mukutarisa avo vakasarudza kurapwa vakaita saizvozvo nekuda kwemafungiro kwete pane zvikonzero zvine musoro. Mune mamwe mazwi, vakasarudza kuva nehutano kunyange zvazvo mumatambudziko akawanda kwakanga kusina uchapupu hwokuti chirwere chavo chaifambira mberi.
Vose mapoka emapoka ekurapa akaongororwa nokuda kwehutano hwehutano hweprostate. Mushure memakore gumi, paiva nevakafa gumi nevaviri vakabatana nekenza yeprostate vakapararira pamwe chete mumapoka matatu-1 muzana yeboka rimwe nerimwe-asi 169 kufa kwakaitika kune zvimwe zvikonzero kunze kwekenza yeprostate. Zvipfumbamwe zvevane gumi nevaviri zvakafa kune varwere vakange vane chikamu chekutanga cheGleason che 7 kana kupfuura. Kufa kwakaziviswa mumurume 8 neGleason 6 asi kubvira panguva iyi muedzo wakagadzirwa makore akawanda akapfuura, kuongororwa kwakavimbwa pane zvinyorwa zvisingashanduki pane kufungidzira nemamiriyoni akawanda anonzi MRI. Dzidzo dzakawanda dzakaratidza zvakajeka kuti biopsy dzisina kukanganisa dzinoshaya chirwere chepamusoro-gwara kakawanda kupfuura MRI yakawanda.
Kunyanya kukosha kubvisa pamuedzo uyu ndiko kuti pakati pemapoka matatu matatu, pakanga pasina mutsauko mukufa kwehuwandu kupfuura makore gumi.
Tora Kurera Chidzidzo
Saka maererano nemashoko aya matsva uye akatendeseka, makore gumi ekufa kwehuwandu anoramba ari nhamba kana akafanana kana murwere anosarudza kuvhiyiwa, kupiswa kwemazuva kana kuongororwa. Zvakadini nehupenyu hwehupenyu? Imwe shamwari inowanikwa kune imwe yataurwa pamusoro apa yakabudiswawo muNew England Journal musi iwoyo iwoyo, ichitaura nezvehupenyu hwehupenyu hwehutano hwezvimwe zvitatu zvinorapwa zvine chokuita nekuita zvepabonde nekugadzira. Nezvebasa rekuita zvepabonde, zvikamu zviviri kubva muzvitatu zvevarume vari muchidzidzo zvakanga zvakasimba vasati vawana kurapwa. Mushure megore rimwe, zviyero zvevarume vakaramba vaine simba, kureva, vaine zvinyorwa "zvakasimba zvakakwana zvepabonde" zvaive zvakadai:
- Kutarisa kushanda = 49 muzana
- Dhiyabhorosi yekunze iri kunze = 38 muzana
- Radical prostatectomy = 15 muzana
Rimwe gore mushure mokutanga kudzidza, varume vakatsvakurudzwawo pamusoro pekuvapo kana kusavapo kwekuvhenekera kwekuvhunga kunoda kushandiswa kwepads. Chikamu chimwe chete chevarume vacho chakashuma kushandiswa kwepadhesi vasati vatanga kudzidza. Zvinetso zvichibva pakuwedzerwa kweusiku nguva yekuzorora kwaive zvakafanana mumapoka ose matatu uye zvakaramba zvakadaro pashure pekurapwa. Mushure megore rimwe, chiyero chevaya vakashandisa pads vaiva:
- Kutarisa kushanda = 4 muzana
- Dhiyabhorosi yekunze kwemasikati = 4 muzana
- Radical prostatectomy = 26 muzana
Kubatana nemigumisiro yezviitiko zviviri zviri pamusoro apa, isu tinokwanisa kupindura zvino mubvunzo wekupi kurapwa kwakagadziriswa kurapwa kwemitengo ine zvishoma zvishoma zvemigumisiro? Kuvhiya, mazairo, uye kushandiswa kwekushanda vose vane zvakagadziriswa zvakazoitika, asi kushingaira kunotarisa kune zvishoma zvingava nemigumisiro .
Chimwe chinokanganisa kumashoko pamusoro pekushingaira kwekucherechedza ruoko mumuedzo wepamusoro ndechekuti kufambira mberi kwekenza, kureva kukanganisa kwemasastasis kwakanga kushoma kudarika kune varume vainge vambovhiyiwa kana kuti miviri yakaenzana nekuenzaniswa nevarume vakanga vari kuongororwa-13 kusvika 16 vachienzanisa nevarume makumi matatu. Saka, kana isu tisingateereri hupenyu hwehupenyu zvachose uye tichitsanangura "kurapa mahara" se "rusununguko rwekukura kwekenza," pane "kupona", boka rekucherechedza rinowedzera kuipa kunze kwekuvhiyiwa kana mapoka emagetsi, pasina misiyano pakati pekuvhiyiwa uye kupiswa kwemhepo .
Zvisinei, sezvakataurwa pamusoro apa, dambudziko rimwe rekududzira miedzo yakagadzirwa makore 15 kusvika ku20 apfuura ndeyokuti vanovimba nekodzero yekugadzirwa kwekombiyuta. Mishonga yemitambo yekuvhiya uye miviri yakachinja zvikuru, kana iripo, pamusoro pemakore 15 apfuura.
Zvisinei, teknolojia yekutarisa kwevarume pakushandura kwakanyatsogadziriswa nekuuya kwekufungidzira kwakarurama nemamiriyoni emitemo. Mafungiro ezuva ranhasi anowedzera kukanganisa kwekushayikwa kwechirwere chepamusoro-soro chisingaoneki, dambudziko rinowanzobatanidzwa nekutarisa rinovimba nokucherechedza nemaitiro asina kuitika. Mazuva ano, ma-multi-parametric MRI teknolojia inogona kugadzirisa zvikamu zvakajeka kuderedza dambudziko rekupedzisira kufambira mberi kwekenza kune varume vanoda kuongororwa.
Raicable Seed Implants
Imwe nzira yakawanda yekugadzirwa kwekwenyanzvi yekugadzirwa kwezvinhu ndeyekuziva kuti inogadziriswa mbeu inogadziriswa inoguma nemakirwe ekurasira kupfuura emirairo yakawanda yemiti. Mune imwe nguva ichangobva kuparidzirwa yepamusoro yekuenzanisa kuenzaniswa kwemigumisiro yemirasi yega yega uye yevhenekeri pamwe nembeu inogadziriswa, kurapwa kwemitengo ine mbeu inogadzirwa yakaratidzwa kuva yakakwirira zvikuru. Vose vevarume vari mumuedzo uyu vaiva nemhando dzakashata dzepakati-panjodzi kana kenza yakawanda yekenza prostate.
Makore mashanu mushure mekurapa, kurapwa kwehuwandu hwemhepo yakasarudzwa chete ndeye 84 muzana asi chirwere chekurasikirwa kwemazuva ane mbeu makumi mapfumbamwe. Pashure pemakore mapfumbamwe, kubatsirwa kwembeu kwaive kwakanyanya. Pasina mbeu, kurapwa kwepakati kwaingova makumi manomwe chete asi 95 muzana yevarume vaigamuchira kusanganiswa kwemazuva uye mbeu yakaramba ichirapa.
Zviri pachena, zvipembenene zvembeu zvinokurudzira zvikuru kurapa mazinga. Pane imwezve mutsva mutsva unotarisa kuti mbeu dzinogadziriswa sei pachako pachavo, pasina chero dhizha remvura. Iyi dambudziko rakadzidza varume makumi mashanu nemakumi mashanu kubva pamasikati kusvika kune mbeu kusvika kune mbeu chete. Ivhareji yeGleason yaive ye7 uye PSA yaiwanzo iri pasi pemakore gumi. Makore mashanu mushure mehutano, chirwere chepuraya chaive chakafanana mumapoka maviri e5 ne8 muzana maererano.
Nguva yakareba yemigumisiro, zvisinei, yakanga isina zvishoma nembeu chete, 7 muzana zvichienderana ne12 muzana yevarume vanogamuchira kubatanidzwa. Uyu muedzo unoratidza kuti mizizi yakawedzerwa kumbeu haifaniri kukosha uye inonyanya kutyisa kupfuura mbeu inonzi radiation inopiwa pachayo.
Interpreting Data
Iwe unofanirwa sei iwe semurwere kubvisa deta iyi? Tichifunga nezvezvikamu zvitatu zvekenza yeprostate, kune avo vanofananidza nehuwandu hwemaprofayiti, kushandiswa kwekutarisa kunowanzoita danho rakanakisisa rokutanga kune varume vane chirwere chisingabatsiri. Iine zvido zvishoma uye zvakafanana nekufa zvinoguma sevaya vanosarudza kuvhiyiwa kana kupiswa kwemhepo. Iye zvino kuti tine nzira yakarurama yekuongorora varume ava nepamusoro-grade yezvirwere ne-multi-parametric MRI, kushandiswa kwekushanda kunova chinhu chakanyanya kunaka.
Varume vane kenza yemukatikati yepamusoro uye ine ngozi yakawanda vanofanira kubatwa ne mbeu inogadziriswa. Chido chekuwedzera kwechidimbu chechiedza chinofanira kunge chakakanganiswa mubvunzo. Iye zvino nedhiyabhorosi yedhidhiyo kuti inotsigire nzira idzi dzisingashamisi, zvose kusava nechokwadi uye kushungurudza kwakapoteredza kusarudzwa kwekurapa kunogona kuderedzwa zvikuru.
> Sources:
> America Cancer Society. Kuponeswa Mari yeProstate Cancer.
> Cooperberg MR. Yenguva refu yekushongedzwa kwekenza yeprostate: mhinduro nemibvunzo. J Clin Oncol. 2015; 33 (3): 238-40.
> Hamdy FC, Donovan JL, Lane JA, et al. Zvibereko zvemakore gumi pashure pekuongorora, kuvhiya, kana kuti Radiotherapy ye Localized Prostate Cancer. N Engl J Med. 2016.