Kyakkyawan gwajin gwajin ciwon ta prostate ya kamata ya gano ciwon sankarar ƙananan ƙwayar cuta yayin da yake guje wa ƙwarewar cutar marasa lafiya, maras kyau (Gleason 6 iri-iri). A baya a shekara ta 2011, Ƙungiyar Ayyuka na Ta'addanci na Amurka (USPSTF) ta bada shawara kan kara gwada PSA a cikin mutanen lafiya saboda karuwa akan maganin cututtukan marasa lafiya.
Matsalar ta kasance ba tare da hannu ba, kadai mafita da zasu iya samuwa shine don raunana PSA. Duk da haka, a cikin shekaru biyar da suka gabata tun lokacin da aka gabatar da waɗannan shawarwari, an bayyana cewa ainihin dalilin rashin ganewar asali shi ne asalin kwayar cutar ta 12-core , ba PSA ba.
Abin takaici, kwayar halitta ta 12-kwayar halitta ta ci gaba da kasancewa ta dacewa a cikin maza da PSA mai girma. Duk da haka, fasahar da aka yi kwanan nan ta ba da wata hanya ta yin bita. Ya nuna cewa hoton tare da MRI (MP-MRI) mai mahimmanci kyauta ne mai kyau don maye gurbin kwayar halitta. Babban abu game da MP-MRI shi ne cewa ya gano ainihin ciwon ciwon gurbataccen ƙwayar cuta ba tare da bincikar cututtukan ciwon ciwon gurgu ba (Stage 6). An gabatar da wasu sababbin binciken da suka dace da wannan batu a taron kungiyar Urology Association (AUA) ta shekara ta 2016 a San Diego. Wannan talifin yayi la'akari da waɗannan muhimman bayanai, yana nuna cewa samfurin prostate a cibiyoyin ingantaccen amfani ta hanyar MT-3-MRI daidai ya gano ciwon daji da yawa kuma yana da amfani a kan biopsy bazuwar.
Nazarin baya bayan gwajin gwaje-gwaje na Ciwon Ƙari
Tun da babban matsalar tare da nunawa PSA shine kusan kullum yakan jagoranci kai tsaye zuwa kwayoyin halittu 12, nazarin farko na so in gabatar da alaka da haɗarin haɗari na kwayoyin halittu.
Dokta Alaina Garbens ya wallafa littafin MP53-13, ya duba sau da yawa maza da aka kwantar da su bayan an samu asibiti.
Ta duba yawan adadin mazauna maza da mata 61,910 wadanda ke da asibiti a cikin Ontario, Kanada tsakanin Janairu 2006 zuwa Disamba 2013. Wannan binciken ya ƙidayar yawan mace-mace da adadin shigarwar asibiti a cikin kwanaki 30 da suka gabata bayan an yi nazarin halittu na prostate.
Sun gano cewa mutuwar mutuwa daga kwayar halitta yana daya daga cikin goma. Kwanan shigarwar asibiti a cikin kwanaki 30 da suka gabata bayan biopsy ya kasance kashi 3.5 cikin dari. Daga cikin kashi 3.5 cikin dari, an shigar da kashi uku cikin hudu na maza don magance cutar. A matsayin bayanin kula na wannan binciken, Dokta Garbens ya lura cewa adadin yawan kwayoyin halittun da aka yi ya ragu kashi 30.6 bisa dari idan aka kwatanta da yawan biopsies da aka yi a gaban shawarwarin USPSTF.
Binciken biyu da aka gabatar a AUA sun dubi yadda shawarwarin USPSTF ke shafar irin ciwon daji da aka gano. Duk waɗannan nazarin suna nuna yawan karuwar yawan ciwon daji da aka gano a tun lokacin da AmurkaPSTF ta ba da shawarwarin ta dakatar da nunawa.
Abstract MP39-04 da Dokta Carl Olsson ya ruwaito cewa an bayar da shawarwarin USPSTF a shekara ta 2011 da shawarar cewa likitoci su daina daukar nauyin PSA-yawancin maza da aka gano da ciwon sukari mafi girma:
Shekara | Men Gleason 8 zuwa 10 |
2010 2011 | 14.8% 14.8% |
2013 | 19.7% |
2014 | 25.4% |
A bayyane yake, yawan mutanen da aka bincikar su da ciwon ciwon sankarar karuwanci suna kara karuwa.
Karin bayani PD09-03 da Dr. Glen Gejerman ya wallafa idan aka kwatanta da fitowar sababbin ƙwayoyin da aka gano kafin da bayan bayanan USPSTF. Ya kimanta mutane 2513 da suka rayu a shekara ta 2011 da kuma 1665 waɗanda suka kasance a cikin shekara ta 2014. Aikin Gleason da aka yi a tsakaninta da 6 a 2011 zuwa 7 a 2014. Yawan Gleason (8-10) da aka gano a cikin kashi 19 cikin dari na biopsies na 2014 kawai Kashi 9 cikin 100 na biopsies da aka yi a baya a shekarar 2011.
Nazarin da ya gabata ya nuna cewa shawarwarin USPSTF da za su rabu da nunawa PSA suna rage adadin mutanen da ke nunawa PSA.
Sakamakon tasiri shine ragewa a ganewar asali na Gleason 6-wani nau'i na ciwon ciwon ciwon gurgu na maza da ke shan kwayar halitta. Wannan shi ne sakamakon da aka tsara na shawarwarin USPSTF. Lokacin da USPSTF ta bayar da shawarwarin a shekara ta 2011, babu wata hanyar maye gurbin yin amfani da kwayoyin halittu na 12 don nazarin maza da matakan PSA masu girma. Saboda haka, don sake komawa kan babbar matsala akan cutar da ƙananan ƙwayar cuta, USPSTF ta yanke shawara don taƙasa PSA gaba daya.
Abin da ake nufi: Wannan shawarwarin zai iya zama ma'ana a baya a shekara ta 2011. Duk da haka, yanzu akwai sabon fasahar da ke samar da wata hanyar da za ta iya dacewa wajen yin nazarin halittu.
Shafuka shida da aka lissafa daga zauren urology na shekara ta 2016 sun nuna cewa kwayar cutar ta MRI da ke gaba daya ta biyo bayan kwayar cutar tace ta gano ƙananan ciwon ciwon gurguwar ƙwayar ƙwayar cuta da kuma rufe matsala na kan-diagnosing grade 6.
Dokta Yasukaza Nakanishi ya wallafa MP16-17 sun kimanta daidaituwa na yin nazarin kwayoyin halitta na mummunan raunuka da aka gano tare da MTA (MP-MRI) na 3T na prostate. Ya kwatanta sakamakon binciken da ake yi na biopsy tare da sakamakon da aka samu ta hanyar yin amfani da kwayoyin halittu 14. A cikin bincikensa, ya kimanta mutane 202 tare da manyan PSA da matakan MRI (MP-MRI). Dukkanin zubar da jini da aka gano da MP-MRI (PI-RADS-3 a sama) an yi niyya. "Ciwon daji na" high-grade "an bayyana shi a matsayin Gleason score ≥4 + 3 ko matsakaicin yawan ciwon daji ≥5 mm. Sun gano cewa kwayar cutar ta gano kashi 88 cikin dari na maza da ke fama da ciwon daji da kuma kashi 97 cikin 100 na maza da ke da cutar wadda ta kasance Gleason 8 ko mafi girma.
Abstract PD15-08 ya wallafa ta Drs. Peter Choyke da Bitrus Pinto sun gano ainihin abin da ke haifar da cututtukan ƙwayar cuta mai zurfi da aka sace su ta hanyar ciwon kwayar halitta a cikin mutane 1003. Sun bayar da rahoton cewa kwayar cutar ta biopsy ta rasa cutar Gleason 7 da aka rasa a cikin kashi 11 cikin dari na maza kuma ba a rasa Gleason 8 ko mafi girma a kashi 2 cikin dari ba. Sake sake dubawa game da hotunan m-MRI na wadannan masu haƙuri sun nuna cewa kashi biyu cikin uku na cikinsu na da ladaran da aka gani wanda likitan ya bace . A kusan dukkanin sauran, likita da ke cike da allurar kwayar cutar kawai ya rasa raunin. Kashi 1 bisa dari na maza ne kawai ke da ciwo na MRI. A wasu kalmomi, a mafi yawancin lokuta rashin nasarar da aka yi wa biopsy don samun ciwon daji ya kasance saboda karatun subordtimal na MRI ko suboptimal da aka yi niyya daga likitan da yake yin kwamin gizon burodi. A bayyane yake, hotunan yana aiki lafiya, amma mai haƙuri yana bukatar ya san cewa ba za a iya dogara ba sai dai idan likitocin da aka horar da su sunyi aiki da kyau.
Karin bayani PD15-11 marubucin Dr. Amanda Lu ya wallafa mahimmancin darajar MP-MRI da aka kwatanta da bazuwar kwayar halitta. "Matsayin da ke da mahimmanci" yana nufin alamar rashin ciwon daji lokacin da yake. Maza tare da PSA mai girma wanda MP-MRI bai nuna wani ciwon da ke fama da mummunan rauni ba. Daga cikin mutane 53 da MIL-MRI ba su nuna nau'i ba, kawai kashi 3.8 ne aka samu don ciwon ciwon daji wanda yake da ciwo mai tsanani (Gleason ma7) kamar yadda ƙwararrun kwayoyin halitta 12 ke nunawa.
Dokar Dokta Jan Philipp Radtke ta wallafe MP21-15 wanda aka kwatanta shi da MP21-15 idan aka kwatanta da daidaituwa na MP-MRI tare da tiyata. Ya kimanta kimanin mutane 120 da suka yi wa MRI jagoran kwayar halitta kafin su tiyata. MU-MRI ta gano 110 (kashi 92) na raunuka masu mahimmanci idan aka kwatanta da binciken binciken bayan binciken. Daga cikin waɗannan, jinsin biopsy ya gano kashi 80 cikin 100 na wadannan raunuka. Bugu da ƙari, wannan ya nuna cewa akwai bukatar samun likitoci masu gwani da ƙwarewa don su yi amfani da biopsy.
MP53-02 da Dokta Joseph Mahon ya wallafa littattafai na maza 395 tare da PSA mai daraja don ciwon ciwon gurguwar ciwon gurgu. Dukkan mutanen sun sami m-MRI kafin su fara nazarin halittu. Mutanen da ba tare da wani ciwon da aka gano ba a kan M-MRI ko tare da marasa tsabta suna zaton ba za su kasance ciwon daji ba (PI-RADS 1-2). Mutum ɗari da sittin da tara da tara sun cika waɗannan ka'idoji kuma an haɗa su cikin binciken. Dukansu suna da kwayar halitta 12-core. Yawanci, an gano cutar ciwon gurgu a cikin 54 (kashi 32) waɗanda 47 (88 kashi) su ne Gleason 6 ko Gleason 3 + 4 mai mahimmanci. Babban cuta, watau, Gleason 4 + 3 an gano shi a kashi 10 cikin 100 na maza kuma Gleason 4 + 4 an lura da shi cikin kashi 2. A wasu kalmomi, mummunar mahimmancin darajar mr-MRI na al'ada a cikin wannan binciken na musamman shine kashi 88.
Mahimman MP53-15 ya wallafa ta Drs. Peter Choyke da Bitrus Pinto sun yi daidai da daidaitattun kwayoyin halitta na MP-MRI a cikin nazari mai yawa. Mutanen da ke cikin binciken sunyi amfani da M-MRI na farko da suka hada da jinsin halittu wanda ya biyo bayan kwayar halitta 12-core. An rarraba irin ciwon daji da aka gano akan cutar ta prostate a cikin sassa uku: Ƙananan haɗari (Gleason 6 ko ƙananan Gleason 3 + 4 = 7), Matsakaici-Risk ( Girma mai girma Gleason 3 + 4 = 7), da Babban Haɗari (Gleason na 4 + 3 ko mafi girma).
An gano kimanin mutane 395 daga 'yan majalisa 4. Binciken biopsy da aka gano ya fi kamuwa da cututtuka fiye da 12-core biopsy (kashi 22.3 bisa kashi 20.3 bisa dari). Bugu da ƙari, haɓakar kwayar halitta ta gano kashi 18 cikin dari na ƙananan Gleason 6 (kashi 15.7 da kashi 19.2). Binciken kwayoyin halitta kawai ya rasa mutane hudu tare da Tsarin Tsakanin Tsakiya kuma wanda ke da ƙananan haɗari da aka gano da kwayoyin halitta.
Abin da ke nufi: Bayanan da suka gabata na shida sun nuna cewa MU-MRI ya jagorancin maganin cutar kwayar cutar ta biopsy da ƙananan cutar a kalla da kuma biopsy bazuwar, idan ba mafi alhẽri ba. Amma ainihin amfani da MP-MRI akan kwayoyin halitta ba kome ba ne ƙananan ƙididdiga don ciwon daji marasa daraja. Sauran kyakkyawa na MP-MRI wasu maza ne zasu iya watsar da biopsy gaba daya. A cikin mutanen da suke buƙatar biopsy, ana buƙatar adadin maniyyi da yawa.
Binciken ƙarshe daga taron na AUA wanda ya dace da wannan batu yana magance matsalar.
MP53-14 Drs ya wallafa shi. Peter Choyke da Peter Pinto daga Cibiyar Cancer ta Cibiyar Cancer a Bethesda, sun binciki yadda tasirin MRI ta fi dacewa da kwayar cutar. Kudin da aka yi wa mutum 100 da ke dauke da kwayoyin halitta ($ 1,410 a kowace mutum) shine $ 141,035. Kwayar cutar ba zata zama ba daidai ba a cikin maza 13 da kuma maza 24.
Kudin farashin MP-MRI na $ 633 da MRI fuska biopsy na $ 2,138. Jimlar kudin da za a samu na MRI na prostate ta farko a cikin mutane 100 tare da marasa lafiya da ciwon dabarar da ke dauke da kwayar cutar biopsy, an ƙaddara su zama $ 107,961.69 da aka ba da cewa mutum 70 za su ci MRI kadai, kuma 30 maza za suyi amfani da kwayoyin halitta. A cikin rukuni na maza kawai da ke ciwon MRI na prostate, mutane 7 za su sami sakamako mara kyau kuma 9 zasu sami sakamako mai kyau. Cikakken kwayoyin halitta yana da kashi 25 cikin dari na kasa da tsinkayar kwayoyin halittu.
Abin da ake nufi: Bayani game da hotuna ta prostate daga taro na urology a shekara ta nuna cewa 3T MRI mai yawanci ya gano ainihin ciwon daji. Abubuwan da suka fi dacewa a kan kwayoyin halitta ba su da yawa: Ƙananan rashin lafiyar da aka samu tare da Grade 6, ƙananan ƙananan kuɗi, ƙananan maza waɗanda ke buƙatar kwayoyin halittu da ƙananan matsaloli daga biopsy. Abinda ya kamata a tuna shi ne cewa mU-MRI mai dacewa yana buƙatar kayan aiki na fasaha da kuma gogaggen, likitoci da aka horar da su waɗanda ke karatun lamarin. Saboda haka, har sai wannan fasahar ya zama mafi girma, za ku iya buƙatar tafiya zuwa wani birni don tabbatar da cewa kuna yin nazarin ku a tsakiyar cibiyar.