Cov qhab nia Gleason yog ib qho txheej txheem ntsuas qib uas tus kws kho mob siv los piav qhia txog cov qe ntshav dawb hauv lub qog prostate uas tsis zoo li qub zoo li cas hauv qab lub tshuab microscope. Tus kws kho mob ntxiv cov qauv feem ntau rau cov qauv qib siab tshaj plaws lossis qib thib ob feem ntau, muab cov qhab nia ntawm 6 txog 10 hauv kev tshaj tawm niaj hnub no. Cov qhab nia Gleason kwv yees tus cwj pwm zoo li cas, tsis yog qhov tsis paub tseeb.
Tus yuam sij takeaways
- Cov qhab nia Gleason ntsuas qhov tsos ntawm cov nqaij mob qog nqaij hlav prostate; nws tsis ntsuas qhov loj ntawm cov qog lossis seb cov qog nqaij hlav puas tau kis mus rau lwm qhov.
- Cov kev kho mob niaj hnub no qhia tias Gleason cov qhab nia txij li 6 txog 10, nrog rau Qib Pawg 1 txog 5. Cov qhab nia ntawm 2 txog 5 tsis raug muab tso rau hauv cov ntaub ntawv biopsy lawm.
- Tus qhab nia Gleason tsuas muaj thaum pom muaj mob qog noj ntshav xwb. Tsis muaj qhab nia Gleason "ib txwm", thiab kev kuaj mob tsis muaj teeb meem tsis yog "Gleason 0".
- Kev ntsuas qib yog kev txiav txim siab ntawm tib neeg uas tau kawm tiav thiab muaj qhov sib txawv ntawm tus neeg saib xyuas mus rau tus neeg saib xyuas tiag tiag; kev xav thib ob ntawm cov ntawv swb yog qhov tshwm sim thiab tsim nyog.
- Cov qhab nia Gleason siv nrog PSA, kev kuaj mob qhov quav digital, MRI thiab kev ntsuas staging, tsis yog siv nws ib leeg xwb.
Ib nrais muag
| Yam | Nthuav dav |
|---|---|
| Nws yog dab tsi | Qib histological ntawm prostate adenocarcinoma |
| Qhov chaw piv txwv | Kev siv koob txhaj tshuaj prostate, TURP chippings, lossis tshem tawm prostate (radical prostatectomy) |
| Leej twg qhia txog qhov ntawd | Kws kho mob qog nqaij hlav, feem ntau yog kws kho mob uropathologist |
| Qhov ntsuas tam sim no siv | Gleason 6 txog 10; Qib Pawg 1 txog 5 |
| Qhov nws tsis qhia koj | Theem, kev kis mus rau lwm qhov, qhov ntim ntawm cov qog, PSA, kev pheej hmoo ntawm cov noob caj noob ces |
| Lub sijhawm ib txwm rau kev tshaj tawm | Feem ntau ob peb hnub ua haujlwm tom qab kuaj lub cev; ntev dua yog tias xav tau cov xim ntxiv lossis kev xav thib ob |
Kuj hu ua
- Gleason qib, Gleason sum, Gleason qauv qhab nia
- Pawg Qib (ISUP/WHO Pawg Qib), feem ntau sau ua "Gleason 3+4=7, Pawg Qib 2"
- Hauv cov chaw kho mob hauv Is Nrias teb: "kev ntsuas biopsy", "qib qhia txog kev kuaj mob prostate", "kev ntsuas qib mob qog nqaij hlav prostate"
Qhov qhab nia Gleason yog dab tsi
Cov qhab nia Gleason piav qhia txog kev tsim qauv, yuav ua li cas cov qauv ntawm cov qog prostate tau teeb tsa hauv cov nqaij mob qog noj ntshav. Cov qauv tau muab qib 1 txog 5. Hauv kev xyaum tam sim no, tsuas yog cov qauv 3, 4 thiab 5 tau muab rau mob qog noj ntshav ntawm kev kuaj biopsy; cov qauv 1 thiab 2 yeej tsis siv lawm vim tias cov tsos mob tam sim no tau lees paub tias yog cov zoo sib xws lossis tsis tuaj yeem sib txawv.
Thaum siv koob txhaj tshuaj, tus kws kho mob yuav ntxiv tus qauv uas pom ntau tshaj plaws thiab tus qauv uas tseem tshuav siab tshaj plaws. Thaum siv prostate uas raug tshem tawm, tus qauv uas pom ntau tshaj plaws thiab tus qauv thib ob uas pom ntau tshaj plaws yuav raug ntxiv, thiab txhua tus qauv me me uas muaj qib siab dua yuav raug tshaj tawm cais ua tus qauv thib peb. Qhov no yog vim li cas lej thiaj tseem ceeb: Gleason 3+4=7 thiab 4+3=7 yog "7" tab sis tus cwj pwm txawv, feem ntau 4+3 muaj kev pheej hmoo siab dua.
Cov Pab Pawg Qib
| Gleason qhab nia | Pawg Qib | Lub ntsiab lus dav dav |
|---|---|---|
| 3 + 3 = 6 | Qib Pawg 1 | Tus qauv qib qis tshaj plaws pom ntawm biopsy |
| 3 + 4 = 7 | Qib Pawg 2 | Cov qauv nruab nrab zoo |
| 4 + 3 = 7 | Qib Pawg 3 | Tus qauv nruab nrab tsis zoo |
| 4 + 4 = 8, 3 + 5 = 8, 5 + 3 = 8 | Qib Pawg 4 | Qib siab |
| 9 los yog 10 | Qib Pawg 5 | Qib siab tshaj plaws |
Cov Qib Pawg tau qhia vim tias "6 ntawm 10" zoo li nruab nrab rau cov neeg mob thaum qhov tseeb nws yog qib qis tshaj plaws uas tau tshaj tawm. Qib Pawg 1 qhia qhov ntawd ncaj ncees dua. Nug koj tus kws kho mob urologist kom paub meej ob qho qhab nia Gleason thiab Qib Pawg ntawm koj daim ntawv qhia.
Vim li cas Gleason qhab nia thiaj li ua tiav
- Yuav piav qhia txog kev ua nruj ua tsiv: qib yog ib qho ntawm cov lus qhia muaj zog tshaj plaws ntawm seb mob qog nqaij hlav prostate yuav ua li cas.
- Yuav faib pawg kev pheej hmoo li cas: ua ke nrog PSA, theem kho mob thiab tus lej ntawm cov cores zoo, qib tso tus mob qog noj ntshav rau hauv cov pab pawg qis, nruab nrab lossis muaj kev pheej hmoo siab uas siv los ntawm cov lus qhia kev kho mob.
- Yuav qhib lossis kaw lub qhov rooj rau kev saib xyuas nquag: ntau tus txiv neej uas muaj kab mob Qib 1 raug saib xyuas dua li kev kho mob tam sim ntawd.
- Yuav npaj staging li cas: qib siab dua feem ntau yuav kom muaj kev thaij duab ntxiv kom nrhiav tau kev sib kis.
Cov txiaj ntsig sib txawv nyob ntawm tus kheej qhov xwm txheej kho mob.
Leej twg tau txais qhab nia Gleason
Tus qhab nia Gleason tsuas yog tsim rau cov txiv neej uas tau kuaj cov nqaij ntawm lub qog prostate thiab cov uas pom muaj adenocarcinoma. Feem ntau yuav xav txog kev kuaj mob qog prostate thaum muaj:
- PSA uas nce lossis nce ntxiv tas li, txhais nrog hnub nyoog, qhov loj ntawm prostate thiab qhov kev hloov pauv sai
- Ib lub prostate uas tsis zoo li qub, tawv, lossis muaj pob thaum kuaj lub qhov quav
- Ib qho mob uas yuav tsum tau kuaj pom ntawm ntau daim duab MRI (feem ntau yog PI-RADS 4 lossis 5, thiab qee qhov mob PI-RADS 3)
- Mob qog nqaij hlav prostate pom muaj nyob rau hauv cov ntaub so ntswg uas raug tshem tawm rau qhov loj ntawm prostate benign
- PSA nce siab thaum lub sijhawm saib xyuas, ua rau rov ua dua lossis tsom mus rau biopsy
Kev kuaj mob tsis yog ua tau txhua zaus uas PSA nce siab. Kev kis kab mob hauv cov zis, kev siv catheter tsis ntev los no, mob prostatitis, kev tso zis tsis ntev los no thiab kev loj hlob tsis zoo tuaj yeem ua rau PSA nce siab. Seb puas yuav kuaj mob yog qhov kev txiav txim siab sib koom uas yuav tsum xav txog hnub nyoog, lwm yam kab mob thiab lub neej ntev.
Qhov qhab nia Gleason tsis tuaj yeem ntes lossis tsis suav nrog
- Nws tsis qhia koj txog theem. Qib tsuas piav qhia txog qhov tsos ntawm cov cell xwb. Seb mob qog noj ntshav puas tau mus txog lub capsule, seminal vesicles, lymph nodes lossis pob txha los ntawm kev kuaj mob, MRI, PSMA PET lossis kev luam theej pob txha.
- Nws tsis ntsuas seb muaj mob qog noj ntshav ntau npaum li cas. Qhov ntev ntawm cov tub ntxhais uas koom nrog thiab tus lej ntawm cov tub ntxhais zoo tau tshaj tawm cais thiab teeb meem.
- Qhov qhab nia Gleason qis tsis suav nrog mob qog nqaij hlav qib siab dua lwm qhov hauv prostate. Kev siv koob txhaj tshuaj kuaj ib feem me me ntawm cov qog. Kev txhim kho thaum phais mob yog qhov paub zoo.
- Kev kuaj mob benign biopsy tsis suav nrog mob qog nqaij hlav prostate. "Tsis pom muaj mob qog nqaij hlav" piav txog cov nqaij uas raug kuaj, tsis yog tag nrho cov qog prostate. Yog tias PSA tseem nce ntxiv lossis cov tsos mob tseem muaj txawm tias tau kuaj ib txwm, rov qab mus ntsib koj tus kws kho mob urologist.
- Nws tsis them rau txhua yam mob qog nqaij hlav prostate. Gleason grading siv rau acinar adenocarcinoma. Mob qog nqaij hlav me me lossis neuroendocrine prostate tsis yog Gleason graded thiab nws tus cwj pwm txawv.
- Nws tsis kwv yees qhov tshwm sim ntawm tus kheej. Cov qhab nia Gleason hloov pauv qhov muaj feem; nws tsis kwv yees ib tus neeg txoj kev mus.
- Nws tsis qhia txog kev teb rau kev kho mob lossis kev pheej hmoo ntawm caj ces. Kev kuaj kab mob germline, cov genomic classifiers thiab imaging teb cov lus nug sib cais.
Kev ntsuam xyuas sib txuas tab sis sib txawv
| xeem | Lo lus nug nws teb | Qhov nws ua tsis tau |
|---|---|---|
| Gleason qhab nia / Qib Pab Pawg | Cov cell mob qog noj ntshav zoo li txawv txawv li cas? | Tsis tuaj yeem qhia qhov chaw, qhov loj me lossis kev nthuav dav |
| Kev kuaj ntshav PSA | Puas muaj lub cim qhia txog biochemical uas tsim nyog rau kev ntsuam xyuas ntxiv? | Tsis yog mob qog noj ntshav tshwj xeeb; tuaj yeem loj hlob los ntawm kev kis kab mob lossis kev loj hlob, thiab tuaj yeem yog ib txwm muaj nrog mob qog noj ntshav uas muaj |
| Kev kuaj mob qhov quav siv digital | Lub qog puas tsis sib xws lossis tawv tom qab? | Tsis pom cov qog nqaij hlav pem hauv ntej thiab cov qog me me |
| Kev Ntsuas MRI Ntau Yam (PI-RADS) | Puas muaj qhov mob uas tsim nyog tsom mus rau qhov biopsy? | Kev xav tias muaj kev kuaj mob tsis yog qib; MRI tsis tuaj yeem muab qhab nia Gleason thiab tuaj yeem tsis pom qee yam mob qog noj ntshav, suav nrog qee yam mob qog noj ntshav qib siab |
| theem TNM | Tus mob cancer tau nthuav dav mus deb npaum li cas? | Tsis muaj lus hais txog qhov tsos ntawm lub cell |
| PSMA PET-CT / kev kuaj pob txha | Puas muaj kev kis mus rau sab nraud ntawm prostate? | Tsis ntsuas cov ntaub so ntswg; cov positives cuav thiab negatives tshwm sim |
| Kev ntsuam xyuas genomic classifier | Cov ntaub ntawv ntxiv txog kev pheej hmoo ntawm cov molecular | Muaj tsawg; tsis hloov qhov kev ntsuas qib |
Qib los ntawm kev siv koob txhaj tshuaj thiab qib los ntawm lub qog prostate uas raug tshem tawm kuj sib txawv. Qib ntawm kev phais qog prostate qhia txog tag nrho cov qog thiab yog qhov kev ntsuam xyuas tiav dua; nws yuav siab dua lossis qis dua qib kev kuaj qog.
Yuav npaj li cas
Tsis muaj kev npaj rau qhov qhab nia Gleason nws tus kheej, nws yog tsim los ntawm chav kuaj mob. Kev npaj siv rau kev kuaj biopsy. Cov txheej txheem sib txawv ntawm cov tsev kho mob thiab ntawm cov txheej txheem transrectal thiab transperineal. Koj chav kho mob cov lus qhia sau ntawv muaj qhov tseem ceeb dua txhua yam ntawm no.
- Cov tshuaj kho mob: qhia rau pab neeg txog cov tshuaj aspirin, clopidogrel, warfarin, apixaban, rivaroxaban, dabigatran thiab lwm yam tshuaj ntsuab lossis AYUSH. Tsis txhob tsum lossis hloov cov tshuaj uas tau sau tseg rau koj tus kheej, tus kws kho mob lossis pab pawg kws kho mob urologist yuav qhia.
- tshuaj tua kab mob: ntau chav muab tshuaj tua kab mob tiv thaiv, tshwj xeeb tshaj yog rau kev kuaj mob transrectal. Cov txheej txheem kho mob sib txawv nrog cov qauv kev tiv thaiv hauv zos.
- Kev npaj plab hnyuv: qee lub tshuab siv tshuaj enema ua ntej kev kuaj mob transrectal; ntau lub tsis ua.
- Kev yoo mov: tsuas yog yuav tsum tau siv tshuaj loog lossis tshuaj loog dav dav xwb, uas yog ib qho uas ib txwm muaj rau kev kuaj mob transperineal biopsy.
- Kev kuaj xyuas kab mob: feem ntau kev kis kab mob hauv cov zis yuav raug kho ua ntej kuaj qhov chaw mos.
- Thauj: npaj ib tug neeg nrog koj mus yog tias siv tshuaj loog.
Cov txiv neej uas muaj mob ntshav qab zib uas siv tshuaj txo cov piam thaj
Yog tias yuav tsum tau yoo mov, nug tus kws kho mob ua ntej seb yuav siv insulin lossis sulfonylurea li cas rau hnub ntawd. Kev yoo mov noj cov tshuaj no yam tsis muaj kev saib xyuas yuav ua rau muaj kev ntshav qab zib tsawg.
Cov txiv neej uas muaj kab mob raum lossis lub plawv tsis ua haujlwm ntev
Qhia rau pab neeg ua ntej yuav siv cov duab thaij uas yuav siv cov xim sib txawv, thiab ua ntej raug hais kom haus dej ntau tom qab ua tiav cov txheej txheem. Cov lus qhia txog cov kua dej yuav tsum tau hloov kho.
Cov neeg laus thiab cov txiv neej noj ntau yam tshuaj
Tham txog seb qhov kev kuaj nqaij puas yuav hloov pauv kev tswj hwm. Rau cov txiv neej uas muaj lub neej luv lossis tsis muaj zog, qhov kev puas tsuaj yuav ntau dua li cov ntaub ntawv tau txais.
Cov txiv neej noj tshuaj anticoagulation
Kev pheej hmoo ntawm kev los ntshav ntau dua. Kev txiav txim siab los nres, txuas lossis txuas ntxiv cov tshuaj anticoagulation yog nyob ntawm tus kheej thiab yuav tsum los ntawm pab pawg kho mob.
Muaj dab tsi tshwm sim thaum lub sijhawm ua haujlwm
Kev kuaj lub cev. Kev siv ultrasound los qhia, feem ntau yog siv nrog cov duab MRI yav dhau los. Kev siv tshuaj loog hauv zos yuav raug txhaj rau hauv. Yuav muab ntau lub cores, feem ntau yog ib qho systematic set ntxiv rau cov cores uas raug tsom los ntawm txhua qhov chaw MRI. Kev kuaj nws tus kheej feem ntau siv sijhawm li 10 txog 20 feeb; nrog rau kev nkag mus, kev pom zoo, kev siv tshuaj loog thiab kev rov zoo, yuav tsum nyob hauv tsev kho mob ob peb teev. Kev siv tshuaj loog transperineal biopsy yuav siv sijhawm ntev dua.
Theem kuaj mob. Cov cores raug kho, ua tiav rau hauv paraffin, faib ua ntu thiab pleev xim. Tus kws kho mob kuaj xyuas txhua lub core, txheeb xyuas mob qog noj ntshav, muab cov qauv thiab xam cov qhab nia thiab Qib Pawg. Immunohistochemistry yuav raug ntxiv thaum qhov tsos tsis meej, uas ntxiv sijhawm. Cov ntawv qhia feem ntau yuav npaj tiav hauv ob peb hnub ua haujlwm; kev tshuaj xyuas los ntawm cov kws tshaj lij lossis xa mus rau cov slides ntxiv hnub ntxiv.
Kev nkag siab txog koj daim ntawv qhia
Daim ntawv qhia txog kev kuaj mob prostate feem ntau muaj ntau tshaj qhov qib. Nrhiav rau:
- Gleason qhab nia sau ua tus lej tag nrhopiv txwv li 3 + 4 = 7, ntxiv rau Pawg Qib.
- Tus naj npawb ntawm cov cores koom nrog tawm ntawm tag nrho cov khoom siv, ib qho chaw.
- Feem pua lossis ntev ntawm txhua lub hauv paus koom nrog los ntawm mob qog noj ntshav.
- Feem pua ntawm tus qauv 4 hauv Gleason 7 tus kab mob, uas cuam tshuam rau kev txiav txim siab saib xyuas.
- Kev nkag mus rau hauv perineural, kev nthuav dav extraprostatic lossis kev koom tes ntawm cov seminal vesicle yog tias pom.
- Carcinoma Cribriform los yog intraductal, ob qho tib si suav tias yog cov yam ntxwv tsis zoo.
- Cov kev tshawb pom tsis yog mob qog noj ntshav xws li high-grade prostatic intraepithelial neoplasia (HGPIN) lossis atypical small acinar proliferation (ASAP), uas tsis yog mob qog noj ntshav tab sis tej zaum yuav ua rau muaj kev saib xyuas tom qab.
Tsis muaj daim ntawv qhia twg txhais tau nws tus kheej. Tus kws kho mob urologist lossis kws kho mob uro-oncologist uas saib xyuas koj qhov kev kho mob yuav tsum nyeem qhov qhab nia ua ke nrog PSA, kev kuaj mob, kev thaij duab, koj lub hnub nyoog thiab koj lwm yam mob.
Ib qho kev nkag siab yuam kev txog Gleason 6
Muaj ntau tus txiv neej nyeem "6 ntawm 10" ua qhov nruab nrab. Nws yog qib qis tshaj plaws uas tau tshaj tawm ntawm kev kuaj mob qog nqaij hlav. Qib Pawg 1 mob qog nqaij hlav tsis tshua kis mus rau lwm qhov, thiab kev saib xyuas nquag yog qhov kev xaiv tseem ceeb, txhawb nqa los ntawm cov lus qhia es tsis txhob tsis quav ntsej. Kev saib xyuas suav nrog kev kuaj PSA raws sijhawm, kev kuaj mob, MRI thiab kev kuaj mob rov ua dua.
Thaum Gleason qhab nia tuaj yeem ua rau yuam kev
Thaum qhov qib qis tsis zoo (undergrading)
- Lub koob txhaj tsis tau qhov kev tsom mus rau qhov hnyav tshaj plaws, qhov kev txwv paub ntawm kev kuaj cov qog me me.
- Kev kuaj mob tsis tu ncua yam tsis muaj MRI tsom, uas feem ntau tsis pom cov qog nqaij hlav pem hauv ntej.
- Muaj tsawg lub cores raug coj mus, lossis tsuas yog siv cov cores los ntawm ib cheeb tsam xwb.
- Muaj me ntsis mob qog noj ntshav hauv lub plawv, ua rau kev ntsuam xyuas tus qauv nyuaj dua.
Thaum qhov qhab nia siab dhau (qhab nia siab dhau)
- Cov yam ntxwv zoo li adenosis, atrophy lossis partial atrophy txhais tsis raug raws li cov qauv mob qog noj ntshav.
- Cov khoom cuav los ntawm cov nqaij mos uas raug tsoo lossis kho tsis zoo uas ua rau cov qauv ntawm cov qog tsis zoo.
- Kev hloov pauv ntawm cov ntaub so ntswg tom qab kev kho mob radiotherapy lossis kev kho mob androgen deprivation, Gleason grading tsis suav tias yog siv tau rau cov ntaub so ntswg kho thiab yuav tsum tau cim raws li qhov ntawd.
- Kev txiav tangential tsim kom muaj qhov kev xav tsis tseeb ntawm cov qog sib xyaw.
Kev sib txawv ntawm cov kws kho mob pathologists
Kev ntsuas qib yog kev txiav txim siab los ntawm kev pom. Kev pom zoo ntawm cov kws kho mob zoo tab sis tsis tiav, tshwj xeeb tshaj yog ntawm ciam teb 3 piv rau 4 uas cais Pawg Qib 1 ntawm Pawg Qib 2. Feem ntau ciam teb ntawd txiav txim siab ntawm kev saib xyuas thiab kev kho mob. Tus kws kho mob urologist tshwj xeeb yuav tsum tau mus ntsib kws kho mob ua ntej txiav txim siab kho mob loj yog qhov kev thov tsim nyog thiab yog ib qho kev coj ua.
Kev Pheej Hmoo thiab Kev Nyab Xeeb
Qhov qhab nia Gleason nws tus kheej tsis muaj kev pheej hmoo rau lub cev. Cov kev pheej hmoo yog nyob ntawm qhov biopsy uas tsim cov ntaub so ntswg, thiab lawv txawv ntawm txoj kev.
Kev kuaj mob los ntawm kev siv ultrasound transrectal biopsy
Ntshav nyob rau hauv cov zis, phev thiab quav yog ib qho uas pom ntau thiab feem ntau yuav nyob ntev li ob peb hnub mus rau ob peb lub lis piam. Ntshav nyob rau hauv cov phev tuaj yeem nyob ntev li ob peb lub lis piam. Qhov teeb meem tseem ceeb yog kev kis kab mob, suav nrog kev kis kab mob hauv cov zis thiab sepsis, vim tias rab koob hla dhau ntawm phab ntsa qhov quav. Kev tiv thaiv tshuaj tua kab mob ntau ntxiv tau ua rau qhov no yog qhov tseem ceeb hauv Is Nrias teb. Kev tso zis tuaj yeem tshwm sim.
Transperineal biopsy
Cov koob txhaj tshuaj hla dhau daim tawv nqaij perineal es tsis hla lub qhov quav, thiab feem ntau cov teeb meem kis kab mob tsawg dua. Tseem muaj kev los ntshav, mob nqaij, mob perineal thiab tso zis tsis tu ncua, thiab kev siv tshuaj loog lossis kev siv tshuaj loog muaj nws cov kev pheej hmoo.
Kev pheej hmoo ntawm cov ntaub ntawv nws tus kheej
Kev kuaj pom tus mob qog nqaij hlav me me uas yuav tsis ua rau muaj kev phom sij tuaj yeem ua rau kev kho mob nrog cov teeb meem ntawm kev tso zis thiab kev sib deev ntev. Qhov no yog vim li cas kev ntsuas qib thiab kev txiav txim siab sib koom tseem ceeb npaum li kev kuaj mob.
Cov cim liab tom qab kuaj mob prostate biopsy
Xwm txheej ceev: nrhiav kev kho mob tam sim no
- Kub taub hau nrog rau kev tshee hnyo, xav tias tsis zoo, tsis meej pem, ua pa sai, lossis lub plawv dhia ceev, tej zaum yuav yog septic
- Tsis muaj peev xwm tso zis tag nrho nrog rau qhov mob thiab qhov mob hauv plab qis
- Los ntshav ntau heev los ntawm lub qhov quav los yog hauv cov zis nrog rau cov ntshav txhaws, kiv taub hau los yog tsaus muag
Tib hnub ntawd: tiv tauj koj pab neeg kho mob urology hnub no
- Kub siab dua li qub yam tsis muaj lwm yam ntxwv ntawm sepsis
- Kub hnyiab thaum tso zis nrog zaus thiab tso zis sai dua
- Qhov mob uas zuj zus tuaj es tsis ploj mus
- Muaj ntshav pom tsis tu ncua hauv cov zis dhau lub sijhawm uas koj lub chaw kho mob tau qhia
Kev Cai: teem caij sib ntsib
- Ntshav nyob hauv cov phev uas nyob ntev li ob peb lub lis piam yam tsis muaj lwm yam tsos mob
- Mob me ntsis ntawm qhov chaw mos lossis qhov quav uas maj mam zoo zuj zus
- Cov lus nug txog koj qib, Pawg Qib lossis cov kauj ruam tom ntej
Cov xwm txheej tshwj xeeb
Cov laus
Qib siab yog txhais raws li lub neej ntev thiab cov kab mob uas muaj feem cuam tshuam. Qib siab rau ib tug txiv neej uas muaj lub neej ntev feem ntau yuav tsum tau kho mob; qib siab tib yam rau ib tug txiv neej uas muaj kab mob hnyav sib tw yuav raug tswj hwm los ntawm kev kho mob hormone lossis kev soj ntsuam.
Cov txiv neej nyob rau hauv kev saib xyuas nquag
Yuav teem sijhawm rov kuaj dua los yog MRI kom paub txog qib nce qib. Qhov pom tseeb tias qib nce siab yuav qhia tau tias muaj kev kuaj zoo dua es tsis yog kev hloov pauv ntawm lub cev tiag tiag.
Tom qab radiotherapy lossis hormone therapy
Kev kho mob hloov pauv qhov tsos ntawm cov cell. Kev ntsuas Gleason ib txwm tsis siv rau cov nqaij ntawd, thiab cov ntawv ceeb toom yuav tsum hais qhov no kom meej.
Cov txiv neej uas muaj kab mob raum ntev lossis tab tom ntxuav ntshav
Kev xaiv tshuaj tua kab mob thiab kev noj tshuaj ua ntej kuaj mob, thiab kev siv tshuaj sib piv rau kev tshuaj ntsuam xyuas theem, yuav tsum tau hloov kho. Qhia rau txhua pab neeg koom nrog txog koj lub raum ua haujlwm li cas.
Cov txiv neej uas muaj keeb kwm tsev neeg muaj zog lossis paub txog BRCA2 variant
Kev txhais lus qib tsis hloov pauv, tab sis kev sab laj txog kev tshuaj ntsuam caj ces thiab kev kuaj kab mob germline yuav raug qhia, thiab nws yuav cuam tshuam rau kev saib xyuas cov txheeb ze thiab cov kev xaiv kho mob tom qab.
Cov qhab nia Gleason hauv cov ntsiab lus Is Nrias teb
- Kev nthuav qhia theem tom qab yog lub ntsiab lus rov tshwm sim. Cov ntaub ntawv hauv tsev kho mob Is Nrias teb tau tshaj tawm ntau zaus tias muaj feem pua ntawm cov mob qog nqaij hlav prostate qib siab thiab kis mus rau lwm qhov thaum kuaj pom thawj zaug ntau dua li hauv cov tebchaws uas muaj kev tshuaj ntsuam PSA dav dav. Yog li ntawd, qhov qhab nia Gleason siab dua thaum kuaj pom qhia txog cov qauv kev nthuav qhia ntau npaum li kev kawm txog tsiaj txhu.
- Terminology: Cov neeg mob thiab cov chaw kho mob feem ntau hais tias "prostate biopsy report", "PSA test" thiab "TRUS biopsy". Qhov qib yuav raug hais tias yog "3+4" yam tsis muaj Pawg Qib, nug ob qho tib si.
- Tshuaj tua kab mob kuj tau tsav ntau lub chaw hauv Is Nrias teb mus rau kev kuaj mob transperineal thiab mus rau kev tiv thaiv kab mob. Kev coj ua sib txawv ntawm cov tsev kho mob.
- Kev txawj ntse txog kev kho mob uropathy yog tsom mus rau hauv cov chaw loj dua. Yog tias koj qhov kev kuaj mob tau tshaj tawm hauv chav kuaj me dua thiab npaj phais loj, tham txog kev tshuaj xyuas daim duab nrog koj tus kws kho mob urologist. Cov blocks thiab daim duab feem ntau tuaj yeem rov qab tau thiab thauj mus los.
- Khaws koj cov slides thiab blocks kom taug qab tau. Sau lub npe ntawm lub chaw kuaj mob thiab tus lej histopathology; koj yuav xav tau lawv rau txhua qhov kev tshuaj xyuas zaum ob lossis rau kev kho mob ntawm lwm lub tsev kho mob.
Tus nqi thiab kev pov hwm hauv Is Nrias teb
Tus qhab nia Gleason tsis raug them cais. Tus nqi nyob hauv tus nqi histopathology rau cov qauv kuaj prostate biopsy, uas yog ib feem ntawm tus nqi kuaj biopsy. Tus nqi sib txawv ntawm tsoomfwv, tpab nyiaj thiab tsev kho mob ntiag tug thiab ntawm cov nroog, yog li thov kom muaj kev kwv yees ua ntej ua qhov txheej txheem.
Cov yam uas cuam tshuam rau qhov koj them:
- Txoj kev kuaj mob biopsy: kev kuaj nqaij los ntawm txoj hlab pas hauv qab kev siv tshuaj loog lossis tshuaj loog feem ntau raug nqi ntau dua li kev kuaj nqaij los ntawm txoj hlab pas hauv qab kev siv tshuaj loog hauv zos.
- MRI ua ntej: MRI ntau yam ua ntej biopsy ntxiv tus nqi sib cais tseem ceeb.
- Tus naj npawb ntawm cov cores thiab cov thawv: histopathology feem ntau yog tus nqi rau ib lub thawv kuaj.
- Immunohistochemistry los yog cov xim tshwj xeeb, ntxiv thaum qhov tsos tsis meej.
- Kev tshuaj xyuas lub tswv yim thib ob ntawm cov duab ntawm lub chaw kuaj mob xa mus.
- Kev zov menyuam thaum nruab hnub piv rau kev pw hauv tsev kho mob, cov nqi kho mob anesthetist thiab cov nqi kho mob hauv chav phais.
- Kev ntsuas theem xws li kev luam theej pob txha lossis PSMA PET-CT yog tias qib siab.
Kev Pov Hwm: kev kuaj mob biopsy ua raws li kev zov menyuam thaum nruab hnub lossis nrog kev nkag mus kawm feem ntau yog them los ntawm cov cai pov hwm kev noj qab haus huv, tab sis kev tshawb nrhiav sab nraud feem ntau tsis yog. Kev them nqi nyob ntawm koj cov nqe lus pov hwm, lub sijhawm tos thiab cov kab lus kab mob uas twb muaj lawm. Paub meej nrog lub rooj pov hwm hauv tsev kho mob thiab koj tus neeg pov hwm ua ntej cov txheej txheem. Cov phiaj xwm tsoomfwv suav nrog Ayushman Bharat PM-JAY them rau kev kuaj mob qog noj ntshav thiab cov pob khoom kho mob ntawm cov tsev kho mob uas muaj vaj huam sib luag; kev tsim nyog thiab cov ntsiab lus pob khoom yuav tsum tau kuaj xyuas hauv zos.
Cov lus dab neeg thiab qhov tseeb
| tswvyim hais ua dabneeg | fact |
|---|---|
| Gleason qhab nia ntawm 6 txhais tau tias muaj mob qog noj ntshav nruab nrab | Gleason 6 yog Qib Pawg 1, qib qis tshaj plaws uas tau tshaj tawm ntawm kev kuaj mob. Qhov ntsuas tam sim no siv yog txij li 6 txog 10. |
| Ib qho biopsy benign txhais tau tias tsis muaj mob qog noj ntshav | Daim biopsy piav qhia txog cov nqaij uas tau coj mus kuaj. Tej zaum yuav tsis pom mob qog nqaij hlav nyob rau lwm qhov ntawm lub qog. Kev soj ntsuam PSA txuas ntxiv yog ib qho kev coj ua. |
| 3 + 4 thiab 4 + 3 zoo ib yam vim ob qho tib si ntxiv rau 7 | Qhov kev txiav txim tseem ceeb. 4 + 3 muaj ntau tus qauv qib siab dua thiab feem ntau muaj kev pheej hmoo ntau dua. |
| Gleason 10 txhais tau tias tsis muaj dab tsi ua tau | Qib siab qhia txog tus kab mob hnyav, tsis yog qhov tshwm sim ruaj khov. Muaj cov kev xaiv kho mob thiab cov txiaj ntsig sib txawv raws li tus neeg mob qhov xwm txheej. |
| Tus qhab nia Gleason qhia rau koj yog tias tus mob qog noj ntshav tau kis mus rau lwm qhov | Qib tsuas piav qhia txog qhov tsos ntawm cov cell xwb. Kev kis mus rau lwm qhov yog ntsuas los ntawm kev kuaj thiab thaij duab. |
| PSA siab dua yeej ib txwm txhais tau tias Gleason qhab nia siab dua | PSA thiab qib yog cov kev ntsuas sib cais. Cov mob qog nqaij hlav qib siab tuaj yeem tshwm sim nrog cov nqi PSA me me, thiab kev loj hlob tsis muaj teeb meem tuaj yeem ua rau PSA nce siab heev. |
| Qib biopsy yog qhov kawg | Qib ntawm lub prostate uas raug tshem tawm yuav txawv ntawm qib biopsy, thiab qib tuaj yeem rov ntsuas dua thaum rov kuaj dua thaum lub sijhawm saib xyuas. |
Lus nug cov lus nug
Puas muaj qhov qhab nia Gleason ib txwm muaj?
Tsis yog. Qhov qhab nia Gleason tsuas yog muab thaum pom muaj mob qog noj ntshav hauv cov nqaij prostate xwb. Kev kuaj mob uas tsis muaj mob qog noj ntshav tsis muaj qhab nia Gleason thiab tsis yog "Gleason 0" lossis "Gleason 2". Cov qhab nia qub dua ntawm 2 txog 5 tsis raug muab rau kev kuaj mob los ntawm koob vim tias cov qauv ntawd tsis ntseeg tau thiab feem ntau sawv cev rau cov nqaij mos zoo.
Yuav siv sijhawm ntev npaum li cas thiaj li tau txais Gleason score tom qab kuaj biopsy?
Cov nqaij yuav tsum tau kho, ua tiav, faib ua ntu, pleev xim thiab nyeem cov kws tshaj lij. Feem ntau cov chav kuaj yuav tshaj tawm hauv ob peb hnub ua haujlwm. Cov xim ntxiv uas muaj immunohistochemical, ib rooj plaub nyuaj, lossis xa mus rau cov duab kom tau txais kev pom zoo ntawm kws kho mob uropathology yuav ntxiv sijhawm. Nug koj pab neeg urology thaum twg koj daim ntawv tshaj tawm yuav raug xa mus thiab yuav sib txuas lus li cas.
Cov qhab nia Gleason puas hloov tau?
Cov qhab nia rau ib qho qauv tsis hloov, tab sis cov qauv tom qab tuaj yeem txawv. Rov ua qhov biopsy thaum lub sijhawm saib xyuas lossis kuaj xyuas lub prostate uas raug tshem tawm yuav qhia tau qib siab dua lossis qis dua. Qhov no feem ntau qhia tau tias cov qauv zoo dua ntawm lub qog dua li qhov mob qog tau hloov pauv.
Kuv puas yuav tsum tau txais kev pom zoo thib ob ntawm kuv cov biopsy slides?
Nws yog qhov tsim nyog, tshwj xeeb tshaj yog thaum qib nyob ntawm ciam teb ntawm Qib Pawg 1 thiab 2, thaum npaj phais loj lossis kho mob radiotherapy, lossis thaum daim ntawv qhia tsis meej. Cov slides thiab paraffin blocks tuaj yeem rov qab tau los ntawm chav kuaj thawj zaug thiab xa mus rau kev tshuaj xyuas tshwj xeeb ntawm uropathology.
Qhov txawv ntawm Gleason qhab nia thiab Pawg Qib yog dab tsi?
Ob leeg piav qhia txog tib cov nqaij. Qhov qhab nia Gleason yog qhov sib sau ua ke ntawm cov qauv, txij li 6 txog 10. Pawg Qib hloov qhov no mus rau 1 txog 5, cais 3 + 4 ntawm 4 + 3, thiab zam kev xav tsis tseeb tias 6 yog qhov nruab nrab. Cov ntawv ceeb toom tam sim no yuav tsum hais ob qho tib si.
Puas yog Gleason 6 yeej ib txwm xav tau kev kho mob?
Tsis tas li ntawd xwb. Muaj ntau tus txiv neej uas muaj tus kab mob Qib 1 tau txais kev saib xyuas zoo, nrog rau kev kuaj PSA raws sijhawm, kev kuaj mob, MRI thiab kev kuaj dua. Qhov kev txiav txim siab kuj tseem yuav ntsuas tus naj npawb ntawm cov cores uas muaj cov noob caj noob ces zoo, qib PSA, cov ntaub ntawv MRI, hnub nyoog thiab tus kheej nyiam. Tham txog cov kev xaiv nrog koj tus kws kho mob urologist es tsis txhob xav tias ob txoj kev twg.
Puas yog MRI muab tau qhab nia Gleason rau kuv yam tsis muaj kev kuaj mob?
Tsis yog. MRI muab ib pawg kev xav tias muaj PI-RADS thiab qhia qhov chaw uas yuav tsum tau kuaj cov nqaij. Kev ntsuas qib yuav tsum tau kuaj cov nqaij hauv qab lub tshuab microscope. MRI kuj tsis tuaj yeem tshem tawm cov mob qog noj ntshav; MRI tsis zoo txo tab sis tsis tshem tawm qhov ua tau ntawm cov kab mob tseem ceeb hauv kev kho mob.
Vim li cas kuv daim ntawv qhia thiaj hais txog cribriform lossis intraductal carcinoma?
Cov no yog cov qauv vaj tse tshwj xeeb uas lees paub tias yog cov yam ntxwv tsis zoo. Lawv qhov muaj nyob tuaj yeem cuam tshuam seb puas muaj kev saib xyuas nquag thiab tej zaum yuav ua rau muaj kev kho mob ntau dua lossis kev saib xyuas ze dua, txawm tias nyob hauv tib qho qhab nia Gleason. Nug koj tus kws kho mob urologist seb cov kev tshawb pom no cuam tshuam li cas rau koj txoj kev npaj tshwj xeeb.
Kuv qhov qhab nia Gleason yuav raug kuaj dua ntau npaum li cas?
Tsis muaj lub sijhawm teem tseg. Cov txiv neej uas saib xyuas lawv tus kheej yuav tsum tau soj ntsuam dua raws li lub sijhawm teem tseg los ntawm lawv pab neeg, feem ntau yog muab PSA, kev kuaj mob, MRI thiab kev kuaj mob dua ib ntus. Cov txiv neej uas tau kho mob feem ntau yuav tsum tau kuaj PSA thiab thaij duab dua li kev ntsuas qib dua.
Qhov chaw
- WHO Kev Faib Tawm Cov Qog: Cov Qog Hauv Qhov Ntsws Thiab Cov Qog Hauv Qhov Chaw Txiv Neej, Lub Chaw Haujlwm Thoob Ntiaj Teb rau Kev Tshawb Fawb Txog Kab Mob Cancer.
- Lub Koom Haum Thoob Ntiaj Teb ntawm Kev Mob Urological Pathology (ISUP) cov rooj sib tham pom zoo txog Gleason grading ntawm prostatic carcinoma, suav nrog cov lus pom zoo xyoo 2014 thiab 2019.
- Epstein JI et al., kev ntsuas qib Gleason niaj hnub no thiab qhov system Grade Group, luam tawm hauv American Journal of Surgical Pathology thiab European Urology.
- Cov Lus Qhia Txog Kev Mob Cancer Prostate ntawm European Association of Urology.
- Cov Lus Qhia Txog Kev Kho Mob Cancer Network Hauv Tebchaws hauv Oncology: Mob Cancer Prostate.
- Pawg Sab Laj Saib Xyuas Kev Tshawb Fawb Txog Kev Kho Mob ntawm Is Nrias teb - Lub Chaw Haujlwm Saib Xyuas Kev Qhia Txog Kab Mob thiab Kev Tshawb Fawb hauv Tebchaws, Cov ntaub ntawv qhia txog Kev Pabcuam Sau Npe Mob Cancer hauv Tebchaws.
- Cov txheej txheem ntawm College of American Pathologists rau kev kuaj xyuas cov koob txhaj tshuaj prostate thiab cov qauv phais prostate radical.
