PSA kuongorora, pamwe necholesterol nedzimwe mimwe miedzo, inowanzobatwa nekuongorora ropa kunoitika panguva yekuongorora kwepanyama kwegore negore. Asi chii chaunofanira kuita kana PSA iri kunze kwenzira yakarongeka pahupoti yebasa rako? Kana ukaongorora kopi yemashoko ekunyora ebhuku rakanyorwa, kujekesa zviyero zvako, unogona kunge wakawana mamwe matsanangudzo anotsanangura (ona pasi apa) ayo anowanzogoverwa mumushumo:
"Izvi zvinongororwa nePSA hazvifanirwi kududzirwa sehupupuriro husingagumi hwekuvapo kana kusavapo kwechirwere chinouraya uye hachifaniri kushandiswa yoga sechirwere chekuongorora kenza. Kuwirirana kwekliniki kunodiwa.
Kureba kwePSA muongorori kunongoratidzira kuvapo kwekenza yeprostate kusvikira biopsy ichiitwa. PSA mijenya inogonawo kukwidziridzwa mu benign prostatic hyperplasia kana mamiriro ekuvhiringidza kweprostate. PSA haigoni kukwidziridzwa mumarume ane hutano kana varume vasina chestatic carcinoma. "
Verbiage yemhando iyi inoratidza kuti danho rinotevera richava biopsy. Muzvokwadi, zvinoreva kuti bhaopsy inenge ichinyatsoitika. Nyeredzi nyanzvi ye prostate yekuongorora varume nepamusoro PSA yaive iyo yegoridhe yekutenderera kwemakore makumi matatu. Kusvikira munguva pfupi ichangopfuura, kutora huwandu hweprotate sampu yekuongororwa microscopic ndiyo nzira chete yekuona kenza yeprotate.
Random Needle Biopsy Procedure
I -12-core random needle biopsy process yakagadzirirwa zvakanaka muitiro unobudirira uye inogona kuitwa neurologist muhofisi yake.
Murume wacho akaiswa pachidimbu chake nemakumbo ake akatasirwa kumucheto wake. Novocain inoridzwa zvakapoteredza prostate uye gumi nembiri, huru-bore borele cores inotorwa nepfuti inotakurwa patsime inoputika kuburikidza ne rectum. Mishonga inorwisa mabhakitiriya inowanzoitwa kuitira kudzivirira utachiona.
Kana ukaita nounyanzvi, chirongwa chebiopsy chinotora maminitsi gumi kusvika ku20.
Mushure mokutora, varume vanowanzoona kubuda mumuguta uye semhara kwevhiki dzinoverengeka. Zvinetso zvenguva pfupi nezvishamiso zvinogona kuitika. Pasinei nemishonga inorwisa mabhakitiriya, nhamba shomanana yevarume (inenge 2 muzana) ichakurira zvirwere zvakakomba zvakakwana zvekuchengetwa mumba. Mafuta akabviswa kubva ku prostate anotorwa kuti aongororwe nachiremba chaiye anonzi chiremba. Migumisiro inowanzowanikwa mukati memakore maviri kusvika matatu.
Kunyoresa Pathology Report
Chiremba achiongorora shanduro yemhuka , chiremba, anorondedzera kuvapo kana kusavapo kwekenza kubva kumakumbo akabviswa kubva kune gland. Kana kenza iripo, chiremba anotaurawo nezvehuwandu hwekenza (nhamba yemakumbo ane kenza) uye chikamu chekenza. Chikoro chekenza ndeimwe yezvinonyanya kuvhiringidza zvekenza yeprostate.
Kare kumashure kwema1960, chiremba anozivikanwa zvikuru, Dr. Donald Gleason, akanyora kuti maitiro emunguva yemberi yekenza yeprostate inogona kufanirwa nemasero emagetsi anoonekwa pasi pe microscope. Akave nekugadzirisa zvirongwa kubva kubva pa2 kusvika kune gumi izvo zvakafanotaura kuti zvinenge zvakadini kuti kenza ipararire (metastasize). Zvikamu zveGleason scoring system zvinoramba zvichiri kushandiswa kusvikira nhasi. Zvimwe zvikamu zvehutano zvakashanduka nekufamba kwenguva.
Kuchinja kukuru kwakange kuve kuwanikwa kwekuti Gleason zvidzidzo zvitanhatu kana zvishoma hazvisi zvakaipa. Kunyange zvazvo aya "masero asina kukwana" ane zvimwe zvekuonekwa kwekenza, zvidzidzo zvezesayenzi zvino dzakagadzirisa kuti Gleason 6 kana kuti zvishoma hazviiti zvishoma nezvishoma. Maitiro masina masero asiri maitiro anofanirwa kuenzaniswa seanorin tumor, kwete chirwere chekenza.
Imhizha Yezvokurapa Mukuchinja
Zvinosuruvarisa, kuchinja kunoitika zvishoma nezvishoma munyika yezvokurapa. Apo iwe kana munhu waunoda awana kopi yemashoko ehurumende yehutano uye ona izwi adenocarcinoma, zvimwe uchaona izvi zvichikuvhundutsa. Vanenge mamiriyoni evanhu vanoenda biopsy gore negore.
Pakati pevanhu vane mamiriyoni mumwe chete, zvishoma pane 100 000 vavo vachaonekwa neGleason 6 (kana kuti pasi) adenocarcinoma.
Imwe mishonga yemukenza yeprostate inozopedzisira yakatanga kugadzirisa kusvika pakuziva kuti kanhi yekenza 6 haisi chaiyo kenza. Zvisinei, muna 2015, inenge hafu yevarume vakawanikwa neBanga 6 (50 000 varume) vakaiswa pamabasa ekucherechedza maziso pane kuva nekuvhiyiwa pakarepo kana kupiswa kwemhepo. Ichokwadi kuti 50% yevarume ava vachiri kurwara zvakanyanya, vachiisa pangozi zvepabonde nekurasikirwa kwekuvhenekera kwekuvhenekera (kusava nehanya) kwechikonzero chisina matambudziko, inonyatsoratidza kuti mishonga yezvoutano inoda kuvandudza. Kutambudzwa kwakadaro kunogona sei kururamiswa mune izvo zvatinoziva zvino pamusoro pegadhi 6 kana kuti pasi pekenza yeprotate?
Cancer Ndeyechina-Tsamba Shoko
Vanachiremba vanotanga kuchinja mafungiro avo, asi zvinotora nguva kuchinja. Chikamu chechinetso ndechekuti kenza ine mazwi mana-tsamba. Mavara aya ane simba, kunyange kana asiri echokwadi. Semuenzaniso, izwi rinosarura racist rinopa chimiro chakanaka. Izwi rokuti "racist," kana kuti kwete izwi racho rakarurama, rinonamatira seglue. Kana vanhu vakawanda vachizvidzivirira pachavo, guiltier vanoonekwa.
Chimwe chine simba chinokanganisa kushanduka ndechekuti makambani makuru emakirate emakiratira e prostate ave akavakwa mumakore makumi mana apfuura. Zvakaoma kuti urologists achinje nzira dzavo uye arege kuita chirwere. Kushandisa nguva muimba yekushanda chikamu chezvakagadzirirwa. Uye zvechokwadi, kusvikira makore gumi apfuura, pakange pasina zvimwe zvingasarudzwa. Kushungurudzwa kwakanyanya kunogona nyore nyore munguva iyo munhu wose aifunga kuti kenza yese yeprostate yakanga iri kutyisa upenyu. Radical therapy yaidiwa pasi rose.
Kusaziva Kwekuongorora
Chimwe chikonzero chokuti varume vane kenza yepamusoro-gwara vachiri kurapwa zvisina kufanira nekuvhiyiwa ndeyekuti varwere uye vanachiremba vanofanana vachiri kufunga kuti ndiyo nzira inonzwisisika. Zvidzidzo zvinoratidza kuti chinonzi 12-core biopsy inokundikana kuona chikwata chepamusoro cheklasi (gorosi 7 kusvikira kune 10) 25 muzana yenguva! Yeuka, mapepa anoiswa muprostate pakarepo , pasina ruzivo rwenharaunda. Tichifunga izvi zvisiri izvo, pane kutya kwakakodzera kuti kenza yepamusoro-grade ingangodaro isina kuonekwa mu prostate. Dzimwe nguva varume vanosarudza kupiwa kurapwa "Kungofanana nekuchengeteka."
Vaya vanosarudza kushanda zvakasimba vanove vane prostate yavo yakashandura makore ose emakore. Vangave vasingazivi, kuti vanachiremba vavo vanoedza kubhadhara kwekusagadzikana kwebhiopsy dzisina kuitika kuburikidza nekudzokorora. Kunyange zvazvo izvi zvisinganzwisisiki uye zvisingabatsiri, zvidzidzo zvekare zvinoratidza kuti nzira iyi yakachengeteka. Vakawanda vevarume avo vane chirwere chepamusoro chegorosi chakanga chisisipo pane bhizinesi yekutanga yakaonekwa nehupenyu hunotevera pashure pokunge kenza iri panguva yakakwana yakakwana kuti iporeswe.
Kufananidza, Kunotarirwa Pane Kurairwa Kwechirwere
Panzvimbo yekufamba nenzira isina kutendeseka yemaitiro ejoopsy, varwere vanogona kuenda kune-center-of-excellence ye prostate kupikisa ne-multi-parametric MRI. Mumaoko ane ruzivo achishandisa zvigadzirwa zvemamiriro ekudenga, kenza yepamusoro-grade inogona kutarisirwa kunze kwekururamisa kukuru kupfuura izvo zvinogona kuwanikwa ne 12-core random biopsy. Mukuwedzera, prostate MRI haina kukanganisa kuvapo kweBanga 6 kana kuti pasi pekenza. Sezvo chirwere chepasera chiri pasi "chakashaikwa" ne prostate MRI, varume vakawanda havadi kushungurudzwa kwekenza kusarudzwa kwekenza.
Kune zvikamu zvishomanana zvekufungidzira zvakapoteredza nyika, zvichida 50 kusvika ku100, izvo zvinoshandisa prostate imaging nenzira yakarurama. Zvinhu zvinokosha zvezvibereko zvinovimbika ndezvi:
- State-of-the-art, 3-Tesla Multi-Parametric MRI (mpMRI) scanners.
- MRI nyanzvi dzakanyatsodzidziswa maitiro ekuita prostate imaging zvakanaka
- Vanachiremba vakanyatsodzidziswa mukududzirwa kweprostate imaging. Kufambira mberi kwekufananidzira kweprostate kuri kuitika nokukurumidza zvokuti kunyange mamwe mapurisa-akazivikanwa nehudhiologists haasati aziva izvo zvigadzirwa zvemazuva ano zvinogona kuitika.
Varume vane mifananidzo yeTTMMRI inoratidza kuti hakuna zvipembenene zvinokanganisa zvinogona kufungidzira kusununguka zvachose uye zvichida kutevera nemamwe mafungiro kana PSA yavo ichingosimudzirwa. Kana chironda chinoshungurudza chikaonekwa, chinonzi biopsy chinoshandiswa kushandiswa pamapuranga matatu kana mana chinogona kurondedzerwa zvakananga pane zvisina kufanira.
Kunyoresa Prostate MRI Report
Chiremba uyo anoverenga tsananguro inopfupisa pfungwa yake yakawanda yezvaakawana, izvo zvinowira muzvikamu zvitatu zvinokosha:
- Hapana uchapupu hwehupamhi-hutachiona hwezvirwere (saka, hapana chidimbu chebiopsy).
- Chilonda chinoshungurudza chinowanikwa. (Chirwere chinopararira chinodiwa.Kana high-grade yechirwere ichiongororwa, humwe hutsika hunoenderana nekupa mazano pamusoro pemishonga inodiwa).
- Nzvimbo isina kunaka inowanikwa. (Zvichida biopsy yakarongwa inogona kuonekwa kana kushandiswa, kuongororwa kwekuenderera mberi neimwe kuvhara kwemwedzi 6 kusvika ku12 inogona kuonekwa).
Nguva yezvipembenene zveBiopsy Ambiguous
Kufungidzira "kunoona" zvinhu zvemarudzi ose kunze kwekenza, kusanganisira chikafu chemavara, nzvimbo dzekuvhiringidzika (prostatitis), uye nodular nzvimbo dze prostatic hypertrophy (BPH). Zvironda zvekunyanya kunetseka ndezviya zvakakura, zviri munharaunda yeperiipheral yeprostate, bulge iyo capsule, kana inosanganiswa neruzivo rwekuyerera kweropa kana kuparadzirwa. Chironda chinonyangadza chinogona kudikanwa kana chiitiko chinotevera chekutevera chichiratidza kuwedzera kwekuwedzera. Ichisarudzo chekuti ichitsvaira chirwere chisina kumira pakarepo kana kuramba ichiongorora ne periodic scan inofanira kuitwa nekuve nekukurukurirana pakati pemurwere uye chiremba anonzwisisa iyi teknolojia itsva.
Rega PSA Screening Pamwechete?
Muna 2011, pamusana pekunyanya kunetseka pamusoro pekuongororwa kwakawanda kubva kuPSA kuongorora uye nokukurumidza random biopsy zvinotungamirira kumigumisiro yakakomba kubva kune zvirwere zvisingadikanwi, US Preventative Services Task Force inorayirwa pamusoro peitiro rekuongorora PSA . Zvidzidzo zvinoratidza kuti vanachiremba vakawanda vekutanga vakatora mazano aya kumwoyo uye vakamira kuita kuongorora zvachose. Asi Task Force inoshaya pfungwa. PSA kuongorora haisi dambudziko. Dambudziko ririkukurumidza kupinda muchiitiko chinongoramba chiripo chero nguva apo kukwirira kwePSA kunoitika. Nzira yakanyatsotarisa, inotsika iyo inotanga nehutano hweprostate uye inotevera nechinangwa chechiopsy apo kusina kuonekwa kunoonekwa kunogona kupedza dambudziko rekurapa.
Mifungo Yokupedzisira
Nyika yezvokurapa inofambisa zvishoma nezvishoma kuti 12-nheyo dzisina njodzi inopesana nenyuchi inotungamirira kukurapa kusinganzwisisiki, kanonzi Gleason-grade 6 kanzira. Gore roga roga muUnited States varume 100 000 vanoonekwa kuti vane "mishonga yekenza" isingabatsiri. Nhamo, vazhinji vavo vanowanikwa majekesa asina kudiwa kana kuvhiyiwa chero zvakadaro. Nhanho yekutanga yekutarisira kwakanaka varume vanotungamira PSA kuongorora kunofanira kuva kushandiswa kwakapararira kwehupfumi hwehupfumi, pane kungomhanyira kuita bhiopsy dzisina kunaka.
> Sources:
> Eggener S, et al. Journal of Urology Vol. 185, P. 869, March 2011.
> Klotz L, et al. Nyaya yeCliniki Oncology Vol. 28, P. 126, January 2010.
> Sakr W, et al. Journal of Urology Vol. 150, P. 379, 1993.
> Thompson I, et al. New England Journal of Medicine Vol. 349, P. 215, July 2003.
> US Preventative Task Force. Prostate Cancer: Kuongorora. May 2012.
> Wilt T, et al. New England Journal of Medicine Vol. 367, P. 203, July 2012.