Gore roga roga 15,000 urologists vanobva kumativi ose enyika vanopinda musangano wegore negore reAmerican Urology Association (AUA) kuti vaudze zvavanowana munguva ichangobva kuwanikwa kubva mukutsvakurudza kwezvokurapa uye vachigovera kuchangobva kuitika mukenza yeprotate. Chiitiko chaMay 2017 chakaratidza kufambira mberi mukutsvaga dzimwe nzira kune 12-core random needle biopsy ye prostate.
Pano, tichakurukura zviviri zveizvi nzira itsva-iyo OPKO 4k kuongorora ropa uye 3T multiparametric MRI (MP-MRI). Zvose zviri zviviri zvinononoka kuderedza kukosha kwekushandisa 12-core random biopsy.
Vanopfuura mamiriyoni evanhu varume vanoenda kune-12-core random biopsy gore negore. Iyi nzira inotungamirira kune zvirwere zvakakomba, kusava nesimba, nezvimwe zvinetso. Chimwe chakaipisisa pane zvose, zvinokonzera kusakosha kusinganzwisisiki kweBanga 6 kenza ye prostate kune varume vanopfuura 100 000 gore negore; pamusoro pemakore 10 apfuura, nyanzvi dzakadzidza kuti Bhizinesi 6 haifaniri kunge yakamboonekwa sekenza panzvimbo yekutanga , sezvo isina chimiro chemaitiro. Kunyange zvakadaro, mushure mekunge vaongororwa neBanga 6-inenge nguva dzose sechigumisiro che-12-core random biopsy-upwards yevarume 50 000 varume gore negore vanovhiyiwa zvakanyanya kana kuti mazai ekurapa izvi zvisingabatsiri mamiriro ezvinhu. Zviri nyore kuona kuti nei nzira dzakasiyana-siyana kune 12-core biopsy dzinobatsira uye dzinofadza.
Makomborero Ekutongerwa Ropa Rakadzika
Mune mharidzo pa 2017 AUA, Dr. Stephen Freedland kubva kuCedars Sinai muLos Angeles akakurukura kukwanisa kweropa reOOPKO 4K kuti afanotaura nezvechirwere chekenza yeprostate (CSC). Izvi zvinotsanangurwa seGleason 7 kana kuti yepamusoro yekenza yeprostate , rudzi rwekenza yeprostate inoda kurapwa.
Iye nevadzidzisi vake vanofananidza kuongororwa kweOpKO kune PSA yakagadziriswa yakagadziridzwa yakakonzerwa nezvimwe zvinhu zvinokosha zvinofananidzira zvakadai sezera remurwere uye kuongorora rectal rectal.
Mhosva yacho yaisanganisira varume 366 uye chiratidzo cheOOPK chakaratidzirwa kuti zvive nehuwandu hwekuvandudza mukururama pamusoro pePSA algorithm yekufanotaura kweCSC. Muedzo wacho wakawanikwawo wakarurama muvarume veAfrica American (vanhu vane huwandu hwepamusoro yekenza yeprostate). Sezvo iri kuongororwa kweropa nyore, OPKO ndiyo inotangira danho rekutanga rekuongorora kwevasingawanikwi nevarume vane PSA mazinga pamusoro pehutano hwakakwana hwezera ravo.
Kufambira mberi muPirate Imaging
Nhoroondo yekare, prostate yakatarisa yakanga isina kururama. Kunyangwe ikozvino, kuongorora kunowanzova itsva zvokuti kenza yekenza yeprotate ichiri kunyanya kunetseka pane 12-core random biopsy. Ichi ndicho chikonzero kufungidzira ndeimwe yenzvimbo dzakanyanya kupisa uye dzinokurumidza kukura pakutsvakurudza kwekenza ye prostate.
Pane huwandu hwekuvandudza marongerwo ekufungidzira ne multiparametric MRI (MP-MRI):
- MP-MRI, pane kungoerekana yakashata, inogona kuva danho rokutanga rokuongorora. A scan preformed panzvimbo yakakwirira yepamusoro yakajeka zvikuru kupfuura bhiopsy dzisina kushandiswa yekuona kemikirini inokosha yekenza yeprotate.
- Kana iyo scan ichinyatsoona kusakanganiswa, nhengo dzesayenzi dzinogona kurondedzerwa zvakananga pamubhedha unogona kushandisa nhamba shoma yezvinyorwa zvinoshandiswa. Kana kenza iripo, ruzivo pamusoro pekirasi yeGleason rakarurama.
- Kutsunga kwemukati wekenza ndeyechokwadi. Semuenzaniso, kupinda kwekenza yemasinical vesicle (kunze kweganda) zvinonyanya kuonekwa neP-MP-MRI pane kuva nemaitiro asina kuitika.
- Varume vane kenza yemukana wakaderera, avo vakasarudza kutarisa mamiriro avo nemabasa ekucherechedza, vane nzira yekushandisa MP-MRI pane kuita 12-core random biopsies nguva dzose uye inoramba iripo.
Chimwe chezvinhu zvinonyanya kukosha mumunda we prostate imaging chave chiri kukurudzirwa kweyunifomu yepamutemo yekuenzanisa nzvimbo dzisina kufanira (zvisiri izvo zvinonzi "zvipembenene"). Iyo inonyanya kuzivikanwa, Prostate Imaging Reporting uye Data System (PI-RADS), zvikwereti zvipembenene pane imwechete kusvika kune shanu. Varwere vanofanira kuziva kuti iyi ndiyo mitsva, uye vanachiremba vanoverenga zvidzidzo izvi vachiri kudzidza kudzidza PI-RADS kune zvakakosha zvikuru.
Vanachiremba Peter Pinto naPeter Choyke vanobva kuNational Cancer Institute vakataura nezvekururama kwePI-RADS yekucherechedza kemukirini inokosha yekenza yeprostate (CSC), iyo zvakare, yakatsanangurwa seGleason 7 kana kupfuura. Vakatarisa 339 varwere vakave ne MP-MRI. Zvipembenene zvisina kuchena zvakaongororwa zvakare nekuita biopsy yakananga. Apo PI-RADS yepamusoro yezvipembenene zvishanu zvakasikwa, CSC yakaonekwa kuti 72 muzana yenguva. Zvisinei, 22 muzana chete yePI-RADS 4 zvipembenene, 12 muzana yePI-RADS 3 zvipembenene uye 10 muzana yePI-RADS 2 zvikwangwani zvakaratidza CSC.
Mashoko aya vakawana kubva vaitungamirira pakati changamire, zvinoita sezvine musoro kufunga kuita Vanosarudzwa biopsy varume vane PI-RADS 4 ne5 maronda uye kungoita vachiongorora varume nokudzokorora MP-MRI muna 6 kusvika 12 mwedzi kana PI -RADS 1, 2, kana 3 lesion inoonekwa.
Ndezvipi Zvakajeka Izvi Zvikwangwani?
Maererano nekutsvakurudza kwakawedzerwa muPI-RADS system yekuverenga MP-MRI, yakanyorwa naDr. Gerald Andriole nevamwe, basa rakakodzera rePI-RADS mazano nevanodzidziswa radiologists vanoda tarenda yekunaka, kwete kungova neruzivo. Mhinduro dzakarurama hazvirevi kungoziva kwenguva yakareba nekuverenga kuongorora. Muchidzidzo ichi, vatsvakurudzi vakatarisa kunyatsoratidzwa kwekuverenga kwePI-RADS kubva kune vana radiologists vane ruzivo rwakasiyana-siyana uye vakaona kuti kunyora hakuna kuchinjirwa nehuwandu hwechiitiko.
Muchidzidzo ichi, chinonzi biopsy chakashandiswa kuenzana nekururama apo radiologist yakapa chirongwa chePI-RADS chirwere chechina kana chechipiri, kana biopsy yakaratidza chikamu cheGleason che 7 kana kupfuura. Muchidzidzo chacho, mifananidzo yevarwere ava yaisarudzwa uye ikatakurwa nevechitatu akapofumadza. Saka ma radiologists, saka, vakadudzira zvose prostate MRIs pachavo. A "kukanganisa" kuverenga yakarondedzerwa sekugoverwa kwePI-RADS 4 kana 5 nehupenyu hwekutevera hwakaratidza Gleason 6, kana kuti hapana kenza chero ipi zvayo. Chimwe "chisina kururama" chaive kuverengwa kwaiva basa rePI-RADS 1, 2 kana 3 apo chiitiko chebiopsy chaiva Gleason 7 kana kupfuura.
Kururama kwekuverenga kwechiremba kwakabva kubva kumazana makumi mashanu kusvika kuzana makumi mashanu kusvika kuzana makumi mashanu uye zvakawanikwa zvakajeka zvakanyanya hazvina kuwirirana nekureba kwechiitiko chechiremba kuverenga MP-MRI. Saka, izvi zvinorevei kumurwere? Zvakazoitika kuti kuunganidzwa kwezvitsanangudzo kubva kumativi mana emakirinikodhi yakapa mhedzisiro yakarurama. Izvi zvinoratidza kuti kubvumirana kwekubvumirana kwe prostate MRI inogona kunge iri nzira yekuvandudza kunyatsofungidzira.
Chii Chinoita Kuti Testosterone Levels Ive neChechi?
Iye zvino iyo MP-MRI iri kuwedzera pakuzivikanwa, mumwe mubvunzo unokosha wakatanga, "Maitiro epasi e testosterone anokanganisa sei kururamisira kwePM-MRI kuongorora?" Iyi inyaya inokosha. Sezvo varume vachikura, maitiro avo e testosterone anoramba achiderera. Sezvo kuderedza testosterone kunonyatsozivikanwa kuva neanticancer effect, idzi idzi dzakadzika sei dze testosterone dzinogona kuchinja MP-MRI?
Chimwe chidzidzo, uyewo chinobva kuNational Cancer Institute, yakarongedza 522 varwere ve hypogonadal. evaMedhia Psa yavo yakanga 6,66 uye evaMedhia testosterone aiva 171. 522 Varume ava vakanga tichienzanisa rimwe, boka yakakura varume vane testosterone evaMedhia aiva 311. Zvakaratidza kuti kuri zvabuda pakati pemapoka maviri akafanana, kunyange pakanga pava yakaderera kuonekwa kwehuwandu hwechirwere chechirwere chinokonzerwa nevarume ve hypo hypoadal (28,8 muzana vs. 37 muzana). Zvisinei, kuonekwa kwemazinga apo chinangwa chakakonzerwa chakanga chaitwa chakanga chakafanana (40.4 muzana vs. 43.6 muzana).
Pakati pevarume 522, 78 vakaramba vachirapa nekuvhiyiwa. Kwokupedzisira zvokurwara mishumo Varwere 78 izvi, (zvichienzaniswa rimwe boka surgically aibata vanhu kwomuzvarirwo testosterone), akaratidza pangozi huru Gleason mamakisi upgrading (22.2 muzana vs. 12,5 muzana), kakawanda seminal vesical kupindirwa (11.1 muzana Vs 6.0 peresenti) uye zvinowanzoita lymph node kupinda (11.1% vs 7.5 muzana). Kubva pamigumisiro iyi yekudzidzira, maitiro ezasi e testosterone anofanira kuita kuti vanachiremba vave vanyori vaduku vezvakanaka zvakawanikwa zvakataurwa pamusoro pePM-MRI.
Chimwe chidzidzo kubva kuYunivhesiti yeCalifornia, kuSan Francisco yakarongedza kuti PI-RADS inofanotaura zvakadini nezvekuwana zvirwere pashure pokuvhiyiwa (zvichida mune varume vane testosterone chaiyo). Muchidzidzo ichi chechirwere 121, vatsvakurudzi vakatarisa kuti PI-RADS yakafanotaura zvakadini kuitika kwechikwata chepamusoro cheGleason (4 + 3 = 7 kana kupfuura) kana kupararira kwekenza kunze kwe capsule ye prostate gland. The MP-MRI asati kuvhiyiwa akaratidza kuti 69 varwere 73 nematambudziko zvokurwara akanga kana PI-RADS 4 kana 5. Apo vanyori vakagumisa kuti PI-RADS mamakisi of 4 kana 5 ari zvikuru vasanonoka kuti vasabatwa uye Kufembera ipa pathology, PI-RADS 4 kana 5 inopfuura-inofanotaura nezvehutachiona hwakaipa kusvika pane imwe nguva. Somuenzaniso, yevarume vose vane PI-RADS 4 kana 5 vasati vambovhiyiwa, zvikamu zviviri chete kune zvitatu zvakawanikwa zvine chirwere chakaipa.
MP-MRI inopawo ruzivo rwakakosha pamusoro pe12-core random biopsy yevarume vari kushanda-kutarisa nzira inowedzera yekugadzirisa Bhara 6 kenza ye prostate. Kutsvakurudza kwemazuva ano kwakagumisa kuti Bhiibheri 6 harina maitiro anokwanisa. Mune mamwe mazwi, haikwanisi kupararira uye haisi kenza chaiye. Kunyatsoongorora kunoita kuti varume varambe vachivhiyiwa uye vachiporerwa kwemakore akawanda.
Kuchenjerera Kuongorora uye Bhara 6 Chirwere cheProstate
Kana ichokwadi kuti varume varikuona zvakatarisa kutarisa havafaniri kuve nehanya neBakala 6, kunyanya kunetseka ndeyokwanisa kuchengetedza Gwaro re7 kana kuti rinopfuura chekenza risina kukanganiswa neyokutanga yemahara. Zvidzidzo zvinoratidza kuti bhiopsy inopararira inoshaya chirwere chepamusoro-grade 25 muzana yenguva. Chidzidzo kubva kuUCSF, chakataurwa pamusoro apa, chakashuma kuti MP-MRI inoona Gleason 4 + 3 = 7 kana kupfuura 95 muzana yenguva. Zviri pachena, chidzidzo ichi chinotsigira chikonzero chokuti varume vane Gleason 6 avo vari kufungidzira kushanda zvakajeka vanofanira kupiwa MP-MRI kuti vaoneke kuti hakuna CSC iyo yakashaikwa nehupopi yakangogara.
Mune imwe dzidzo, boka rechiremba rinowanikwa muna Ann Arbor, kuMichigan rakatarisawo nyaya yekuita MP-MRI mune varume vachitsvaga kuongorora. Vakarongedza kudzoka kwevarume 225, 209 neGleason 3 + 3 = 6 uye 16 naGleason 3 + 4 = 7. Vose vakave pasi peMP-MRI yakazotevera nechinangwa chechiopsy kana paiva neshungu yakakanganisika. Migumisiro yakaratidza kuti pasina kuve nePM-MRI, varwere 12 vane chirwere chepamusoro chegorosi vangave vasisipo uye vangave vasina kuiswa pamusana pekutsvaga. Bhizinesi yakarongwa yakaratidza Gleason mapurogiramu ekuvandudza kuGleason 4 + 3 = 7 muvarwere vaviri, kuGleason 4 + 4 = 8 muvatano 9 uye kuGleason 4 + 5 = 9 mune mumwe murwere.
Shoko Rinobva
I-12-core random biopsy, yekutanga yakagadzirwa kuma1980 ekupedzisira, yaiva, pane imwe nguva, nzira imwechete yekuziva nayo kenza yekare yepadate. Zvisinei, isu zvino tinoziva kuti gore rega rega varume vanopfuura 100 000 vane chirwere chechigadziriro chisina chakaipa 6 vanowanikwa nevanosarudzira bhiopsy. Izvi zvinokonzera kurapwa zvisina kufanira mumakumi mashanu evanhu varume gore negore. Kusvikira tadzidza kugadzirisa izwi rinotyisa rinosanganiswa neBanga 6, kudzivirirwa kwakanakisisa ndekudzivisa kusanganisa 12-nheyo yesiriyo biopsy zvachose. Varume vane pSA dzepamusoro vanofanirwa kufunga nezvekuita chirwere cheAOPKO 4K. Kana zviitiko zvekuedza zvichiratidza kuti njodzi yepamusoro-grade yepamusoro inopfuura 10 muzana, MP-MRI panzvimbo yepamusoro-soro ingava danho rinotevera rakanaka.
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