Lokacin da nake horo don zama likita a cikin shekarun 1980, jarrabawan PSA da muka yi amfani dashi yanzu don magance cutar ta prostate bai riga ya kasance ba, kuma gano tumocin prostate mafi yawancin abu ne da dama.
Magunguna ko dai sun faru ne a kan wani yunkuri mai yaduwa yayin da suke gwada prostate masu haƙuri tare da yatsan hannu a yayin bincike na yau da kullum ( jarrabawar jarrabawar dijital na yau da kullum), ko kuma ya tabbatar da ganewar bayan bayyanar cututtuka a ƙarshe ya sa mutum ya tsara aikin likita don gano abin da ba daidai bane.
Babu wani labari wanda ya dace don samun karuwar cutar ta prostate a farkonsa, kyakkyawar matsala.
Shekaru talatin da suka wuce, rabi na sababbin cututtuka da suka kamu da cutar da ke fama da ciwo mai karuwanci wanda ya riga ya yada zuwa wasu sassan jiki bayan lokacin da aka gano shi. Magunguna mafi yawan karuwanci na karuwan da nake yi a matsayin mazaunin urology yana cire masu binciken kwayoyin cutar - wani ƙoƙari na magance ciwon daji na cike da ciwon daji ta hanyar yunwa da su daga testosterone cewa ciwace-ciwacen da ke amfani da man fetur.
PSA Pluses
Zuwan gwajin PSA a shekarun 1990 ya ba mu damar yin yaduwa don ciwon ciwon gurguwar ƙwayar cuta kamar yadda muke neman babban matakin ƙwayar cholesterol a matsayin alama na farko na cututtukan zuciya. An gwada miliyoyin maza, kuma sakamakon ya taimaka mana gano magungunan cututtukan da za a iya magance su, kamar yadda jaririn Ben Stiller ya nuna.
Wani gwajin "PSA" a shekara 50 zai iya nuna lafiyar dan mutum na bunkasa ciwon kwari da kuma taimaka masa da likita su yanke shawarar sau da yawa a sake yin gwajin.
Idan karatun bai zama ƙasa da 0.7 nanograms / milliliter (yawancin yawancin shekarun 'yan shekaru 50), rashin lafiyar rayuwa na ciwon gurguwar ƙwayar cutar ba kasa da kashi 10 cikin 100 da kuma zangon PSA na gaba ba za'a yiwu ne kawai a cikin shekaru biyar. Idan matakin ya kasa da 2 Nanogram / milliliter a shekara ta 60, haɗarin samun ciwo mai karuwanci na rayuwa ko mutuwar shi ne kawai kimanin kashi 2 zuwa 3, da kuma biyo baya Ana iya rage ko kawar da gwajin PSA.
PSA Minuses
Duk da yake gwajin PSA yana da darajar, ba shi da cikakke . Ya ƙaddamar yawan adadin sunadaran da ake kira antigen-specific antigen, ko PSA, kewaya cikin jini. Ana yin PSA a jikin sel a cikin glandan prostate. Duk da yake matakin da PSA mai daraja zai iya zama saboda ciwon daji, lambobin kuma za a iya tashe su ta wasu yanayi na kiwon lafiya, irin su cututtuka da kuma kara girman karuwanci wanda ya faru a matsayin maza. Ko da kwatsam, babban PSA ya karu daga gwajin gwaji zuwa gaba-wata ji da ake kira gudu PSA - ba alamaccen abin dogara ba da kanta game da ciwon ciwon ciwon kwari.
Bugu da ƙari, babu cikakke-yanke, matakin duniya na "al'ada" na PSA. Mutane da yawa waɗanda ke da matsayi na PSA a cikin jininsu ba su da ciwon ciwon kwari, yayin da wasu ƙananan PSA sun yi. Akwai kuma shaidu cewa matakan PSA da sauran halaye na PSA sun bambanta a cikin mutanen Amurka kamar yadda suke fata.
A sakamakon wannan mummunan yanayi, wasu mutane ba su da wata magungunan karuwanci na karuwanci kuma zasu iya kawo karshen ciwon daji wanda ba lallai ba, yayin da sauran maza da suke bukatar magani ba a gano su ba da sauri.
Matsalar Tsinkaya
A ƙarshe, sakamakon PSA kadai ba zai iya hango koyi game da ciwon ciwon ciwon daji na gaba ba.
Yawancin ciwon ƙwayar prostate suna da mummunar haɗari, suna girma sosai a hankali, suna sa ko kaɗan ko alamun bayyanar, kuma basu buƙatar magani. Sauran ciwace-ciwacen suna ci gaba da sauri kuma suna iya yaduwa zuwa wasu sassan jiki. Babu shakka muna so mu san irin irin ciwon daji da mai haƙuri ya yi don haka za mu iya yin maganin maganin lafiya, amma matakin PSA ba zai taimaka mana ba.
Wani kwayar halitta na prostate , wanda samfurori na samfurori daga wurare masu dadi don gwajin gwaje-gwaje, zasu iya taimakawa wajen rarraba ciwace-ciwacen ƙananan ƙwayoyin cuta kamar matsananciyar matsakaici, ko matsananciyar haɗari ta hanyar amfani da layin da ake kira Gleason.
Kuma mahimmin gwajin gwaji mai kyau shine rage yawan buƙatun biopsies, tun da yake basu da dadi, haifar da damuwa kuma suna da tasiri.
Bisa gagarumar labari shine ingantattun gwaje-gyaren gwaje-gwaje da sauran kayan aiki na bincike suna samun samuwa, wanda ya kamata ya taimake mu da "ciwon daji / ba ciwon daji" da "ƙaddarar sauri" kayyadewa ba. Bari mu duba.
Gwaje-gwaje-gwaje na Smarter
An nuna gwaje gwaje-gwaje da yawa akan kasuwa da yawa fiye da gwajin PSA akan ganowa ko rashin ciwon ciwon kwari, kuma a gano wasu cututtuka da suka kamata a bi da su. An yi amfani dasu tare da-ba maimakon gwajin-PSA ba, kuma ana nufi don taimakawa marasa lafiya da likitoci su yanke shawara ko ana bukatar biopsy bayan an sami sakamako na gwajin PSA.
Jinin da jini ko gwagwarmayar gwaje-gwaje sun haɗa da 4Kscore ™ , La'idar Lafiya ta Lafiya, Maɓallin Mi-Prostate, da kuma ExoDx ® Prostate (IntelliScore). Kowace nazari na musamman, haɗin kai na masu sarrafa halitta , ko alamun nazarin halittu, na ciwon daji. Wasu sun auna PSA, amma a hanyoyi daban-daban fiye da gwajin gwaji. Alal misali, gwajin (ba tukuna na kasuwanci ba) da aka kira IsoPSA ™ wanda Cibiyar Cleveland Clinic da Cleveland Diagnostics, Inc. ta haɓaka, suna nema a canje-canje a cikin tsarin kwayoyin protein na PSA.
Kodayake sababbin gwaje-gwaje na gwaje-gwajen sun rage yawan kwayoyin halitta, ba Madamai ko masu zaman kansu a halin yanzu zasu biya su a kan su na yau da kullum (wasu masu ɗaukan hoto zasu iya ɗaukar su a kasuwanni na gida) - mai yiwuwa, daga damuwa da suka damu da cewa gwajin PSA ya samu da yawa marasa ciwo marasa lafiya wanda basu buƙatar a bi da su. Marasa lafiya na iya ɗaukar kudin, wanda zai iya zama daloli da dama.
Wadannan gwaje-gwaje suna da amfani a cikin lokuta inda ba a bayyana ba idan wani cigaba mai tsanani PSA na nuna ciwon daji, kuma a cikin marasa lafiya tare da PSA mai tashi da kuma kwayar cutar ta baya.
Kyakkyawan Hanyar Ci Gafa
Ga mutanen da ke da nasaba daga sakamakon wadannan gwaje-gwaje, mataki na gaba shine biopsy. A cikin wannan hanya muna daukar samfurori na jikin prostate don likita don bincika a karkashin wani microscope don sanin idan akwai ciwon daji. An samu kwanan nan, cigaba da karuwa a nan, ma.
Don samun samfurori na samfurori, zamu tsaftace jerin dogayen (daga 12 zuwa 24) zuwa sassa daban-daban na glandan, wanda ya jagoranci ta hanyar nazarin duban dan tayi. Mun yi amfani da wannan hanyar tun daga shekarun 1980. Rashin karuwan ƙananan ne, game da girman irin goro, don haka hotunan dan tayi yana taimaka mana mu sanya allurar da kyau. Amma hotunan ba cikakkun bayanai ba ne don mu gaya wa masu tsattsauran ra'ayi, masu yiwuwar yankuna daga nama na al'ada.
Gaskiyar ita ce muna amfani da fasaha mai tsaida, muna fatan cewa, idan kututture ya kasance, akalla ɗaya daga cikin allurar za ta hadu da shi. Wadannan bazuwar biopsies zasu iya rasa wasu ciwon daji masu cutar, yayin bayyanar da wasu da ba su da mahimmanci kuma zasu iya kawo karshen rashin biyan bukata.
Abin farin ciki, wani MRI da ake kira Muriya multiparametric zai iya rarrabe tsakanin mummunan lalata da kuma zubar da jini.
Zai zama da wuya a yi biopsy yayin da mai hakuri yake cikin hotunan MRI . Amma ba mu da. Sabuwar software ta bamu damar haɗuwa, ko kuma fuse, wadanda cikakken labarun MRI suna nazari tare da rayayye, ainihin lokacin duban dan tayi don shiryar da allurar biopsy. Mai haƙuri na farko yana shan MRI. Wani mai kula da ilimin rediyo yayi nazari akan haka kuma yana nuna alamun wuraren da ba a san su ba. Daga baya, a cikin wani aikin aikin tiyata, muna saka sautin duban dan tayi a cikin magunguna, kusa da prostate.
Gidan fuska ya haɗa da MRI da aka riga ya kasance da kuma hotunan duban dan tayi. Yayin da muke motsa binciken binciken duban dan tayi a kusa da prostate, software yana canza image ta MRI, yana ba mu cikakken bayani, 3-D. Hakanan zamu iya amfani da wannan samfuri don janyo hanzarin daji na kwayoyin daji da muke so muyi samfurin maimakon yin wasa da kuma fatan muna samun wani abu. Yana son amfani da wayarka ta GPS don isa ga makiyaya maimakon tuƙi ba tare da hanyoyi ba.
Kalubale tare da wannan tsarin, wanda ake kira MRI / translatoral ultrasound (TRUS) mai cin gashin kanta, ya sake biya. Binciken yana kimanin $ 1,500 kuma kamfanonin inshora ba zasu biya shi ba a cikin marasa lafiya da suke da ciwon su na farko. Za su rufe shi idan an yi amfani da su a cikin kwayar cutar biopsy ko kuma a cikin marasa lafiya da aka gano a baya da ciwon daji na prostate.
Rayuwa da kwayar halitta ba ta da cikakke. Ɗaya daga cikin binciken ya gano cewa yana da kusan yawancin ciwon sukarin da ke ciwon prostate kamar yadda yake da biopsy. Amma cututtukan da ya yi kuskure ne mafi kusantar zama marasa lafiya marasa lafiya wanda basu buƙatar a bi da su. Kuma rayayyun halittu masu tasowa yana da matukar kyau a yayin da aka gano mummunan ciwon sukari.
Sanarwar Cutar Cancers
Don taimaka mana har da wannan kima, akwai sababbin gwaje-gwajen da za su iya nazarin kwayar halittu ta biopsy don alamun cututtukan ƙwayar cutar. Wadannan kwayoyin gwaje-gwajen-Oncotype DX ® Tsarin Halittar Ƙasa, Decipher ® Ƙwararren Ƙwararren Ƙwararren Ƙwararru, ProMark ® Testomic Test Test da kuma Prolanci ® gwajin gwaji na DNA wanda ya zama alama ce ta ci gaba da ciwon sukari.
Bugu da kari, gwaje-gwajen Oncotype DX da ProMark na iya hango ko akwai cutar ciwon daji mai girma da ke ɓoye a wani wuri a cikin prostate, a yankunan da ba a samo su tare da allurar biopsy ba. (Cibiyar Cleveland Clinic ta taimaka wajen inganta Oncotype DX kuma ta shiga cikin bincike da aka tabbatar da Decipher da ProMark.)
Medicare da wasu kamfanonin inshora suna daukar nauyin wadannan gwajin gwagwarmaya ga marasa lafiya waɗanda sakamakon binciken su (Gleason scores da na ambata a baya) ya nuna rashin ciwon ƙwayar ƙwayar ƙananan. Wadannan yawanci ba su biya bashin gwaji a lokuta inda Gleason ke nuna matakan tsaka-tsaka-tsaka-tsalle ko haɗari.
Tare da sakamakon wadannan gwajin kwayoyin, likitoci da marasa lafiya zasu iya yin shawarwari game da yadda za a ci gaba-ko dai dai da gaggawa kamar maganin ƙuƙumi na prostate, ko kulawa mai mahimmanci, wanda ke nufin dubawa na lokaci da sake sake dubawa game da yanayin ciwon daji.
Dokta Klein shi ne shugaban Cibiyar Urological & Kidney, Cleveland Clinic na Cibiyar Urology ta Kwalejin Cleveland, wadda ta kasance a cikin jerin abubuwan da Amurka ta bayar.
> Sources:
> de Rooij M, Hamoen EH, Fütterer JJ, et al. Daidaitaccen MRI multiparametric don ganewar cutar ta prostate: wani zane-bincike. AJR Am J Roentgenol . 2014 Feb; 202 (2): 343-51.
> Klein EA, Cooperberg MR, Magi-Galluzzi C, et al. Hakanan kwayoyin halitta ta 17 sun hango fatalwar ciwon ciwon daji a cikin mahallin Gleason sabo, mahaukaciyar jiki, da biopsy undersampling. Eur Urol . 2014 Sep; 66 (3): 550-60.
> Hegde JV, Mulkern RV, Panych LP, et al. Multiparametric MRI na ciwon daji na prostate: sabuntawa game da fasaha na gari da kuma aikin su a gano da kuma gano wurin ciwon kwari na prostate. J Magn Reson Hoto . 2013 May, 37 (5): 1035-54.
> Brawley OW, Thompson IM Jr, Grönberg H. Bayyana Sharuɗɗa a kan Labaran Ciwon Kankara. Am Soc Cibiyar Nazarin Ilimin Ilimi . 2016; 35: e80-7.
> Loeb S, Catalona WJ. Labaran Lafiya na Lafiya: sabon gwajin don gano cutar ta prostate. Ther Adv Urol . 2014 Afrilu 6 (2): 74-7.