Inqaku leGleason yinkqubo yokubeka amanqaku esetyenziswa yingcali yezifo ukuchaza indlela iiseli zomhlaza weprostate ezingaqhelekanga ezibonakala ngayo phantsi kwemakroskopu. Ingcali yezifo yongeza ipateni eqhelekileyo kwipateni ephezulu okanye yesibini eqhelekileyo, inika amanqaku ukusuka kwi-6 ukuya kwi-10 kwiingxelo zanamhlanje. Inqaku leGleason liqikelela indlela yokuziphatha enokwenzeka, hayi ukuqiniseka.
Ukuthatha okuphambili
- IGleason inika amanqaku ngendlela imbonakalo yezicubu zomhlaza weprostate; ayilinganisi ubungakanani bethumba okanye ukuba umhlaza usasazeke na.
- I-pathology yanamhlanje ibika amanqaku eGleason ukusuka kwi-6 ukuya kwi-10, kunye neBanga leQela loku-1 ukuya kwi-5. Amanqaku ukusuka kwi-2 ukuya kwi-5 awasabelwanga kwizinto ze-biopsy.
- Inqaku leGleason lifumaneka kuphela xa kufunyaniswa umhlaza. Akukho nqaku "eliqhelekileyo" leGleason, kwaye i-biopsy engeyongozi ayisiyo "Gleason 0".
- Ukubeka amanqaku yindlela eqondwa ngabantu kwaye inokwahluka kokwenyani phakathi komjongi nomjongi; izimvo zesibini kwislayidi ziqhelekile kwaye zisengqiqweni.
- Inqaku leGleason lisetyenziswa kwi-PSA, uvavanyo lwedijithali lwe-rectal, i-MRI kunye ne-staging scans, kwaye alisetyenziswa lodwa.
Ngokukrwaqula kanye
| umcimbi | inkcukacha |
|---|---|
| Yintoni | Uhlobo lwe-Histological lwe-prostate adenocarcinoma |
| Umthombo wesampulu | i-prostate needle biopsy, ii-TURP chippings, okanye i-prostate esusiweyo (i-radical prostatectomy) |
| Ngubani oxelayo oko | Ingcali ye-Histopathologist, edla ngokuba yingcali ye-uropathy |
| Isikali esisetyenziswa ngoku | IGleason 6 ukuya kwi-10; Iqela leBanga 1 ukuya kwi-5 |
| Oko ingakuxeleli kona | Inqanaba, ukusasazeka, ubungakanani bethumba, i-PSA, umngcipheko wemfuza |
| Ixesha eliqhelekileyo lokunika ingxelo | Ngokwesiqhelo iintsuku ezimbalwa zokusebenza emva kwe-biopsy; ixesha elide ukuba kufuneka amabala angaphezulu okanye uluvo lwesibini |
Kwaziwa njenge
- Ibanga leGleason, isamba seGleason, amanqaku epateni yeGleason
- Iqela leBanga (ISUP/WHO Grade Group), lidla ngokubhalwa ngokuthi "Gleason 3+4=7, Iqela leBanga lesi-2"
- Kwiikliniki zaseIndiya: "uvavanyo lwe-biopsy", "uvavanyo lwengxelo ye-prostate biopsy", "uvavanyo lovavanyo lomhlaza we-prostate"
Yintoni amanqaku eGleason
Inqaku leGleason lichaza uyilo, indlela izakhiwo ze-prostate gland ezicwangciswe ngayo kwizicubu ezinomhlaza. Iipateni zibekwe kwinqanaba loku-1 ukuya kwelesi-5. Okwangoku, ziipateni 3, 4 kunye no-5 kuphela ezinikwa umhlaza kwi-biopsy; iipateni 1 kunye no-2 azisasetyenziswa kuba ezo mbonakalo ngoku zibonwa njengee-benign micali okanye azikwazi ukwahlulwa ngokuphindaphindiweyo.
Kwi-biopsy yenaliti, ingcali yezifo yongeza eyona patheni ixhaphakileyo kunye nepatheni ephezulu eseleyo. Kwi-prostate esusiweyo, kongezwa eyona patheni ixhaphakileyo kunye neyesibini exhaphakileyo, kunye nayo nayiphi na ipatheni encinci yebanga eliphezulu echazwe ngokwahlukeneyo njenge-tertiary. Yingakho i-arithmetic ibalulekile: I-Gleason 3+4=7 kunye ne-4+3=7 zombini zi-"7" kodwa ziziphatha ngokwahlukileyo, apho i-4+3 ngokubanzi ithwala umngcipheko ophezulu.
Amaqela eBanga
| Amanqaku eGleason | Iqela leBanga | Intsingiselo ngokubanzi |
|---|---|---|
| 3 + 3 = 6 | Iqela leBanga lesi-1 | Ipateni yebanga eliphantsi ibonwe kwi-biopsy |
| 3 + 4 = 7 | Iqela leBanga lesi-2 | Ipateni ephakathi efanelekileyo |
| 4 + 3 = 7 | Iqela leBanga lesi-3 | Ipateni ephakathi engalunganga |
| 4+4 = 8, 3+5 = 8, 5+3 = 8 | Iqela leBanga lesi-4 | Ibakala eliphezulu |
| 9 okanye 10 | Iqela leBanga lesi-5 | Ibanga eliphezulu |
Amaqela eBanga aqaliswa kuba "6 kwi-10" ivakala iphakathi kwizigulane ngelixa eneneni ilona banga liphantsi elixeliweyo. Iqela leBanga loku-1 lithetha loo nto ngokunyaniseka. Cela ugqirha wakho womchamo ukuba aqinisekise amanqaku eGleason kunye neQela leBanga kwingxelo yakho.
Kutheni amanqaku eGleason egqityiwe
- Ukuchaza ubundlongondlongo: iGrade yenye yezona zinto zibalaseleyo ezibonisa indlela umhlaza weprostate onokuthi uziphathe ngayo.
- Ukwabela udidi lomngcipheko: Xa idibene ne-PSA, inqanaba leklinikhi kunye nenani lee-cores ezintle, olu didi lubeka umhlaza kumaqela aphantsi, aphakathi okanye anobungozi obukhulu asetyenziswa yizikhokelo zonyango.
- Ukuvula okanye ukuvala ucango lokujonga okusebenzayo: Amadoda amaninzi anesifo seBanga loku-1 anikwa ingqwalaselo endaweni yonyango olukhawulezileyo.
- Ukucwangcisa iqonga: umgangatho ophezulu udla ngokubangela ukuba umfanekiso wongezelelekileyo ukhangele ukusasazeka kwawo.
Iziphumo ziyahluka ngokuxhomekeke kwiimeko zeklinikhi zomntu ngamnye.
Ngubani ofumana amanqaku eGleason
Amanqaku eGleason enziwa kuphela kumadoda athathe iisampulu zezicubu zeprostate kwaye afunyenwe kwi-adenocarcinoma. I-prostate biopsy idla ngokuqwalaselwa xa kukho:
- I-PSA ephakanyisiweyo okanye enyuka rhoqo, echazwa ngokweminyaka, ubungakanani beprostate kunye nesantya sotshintsho
- I-prostate engaqhelekanga, eqinileyo okanye enamaqhuqhuva xa kuhlolwa i-rectal yedijithali
- Isilonda esirhanelekayo kwi-MRI ye-multiparametric (esidla ngokuba yi-PI-RADS 4 okanye 5, kunye nesilonda esikhethiweyo se-PI-RADS 3)
- Umhlaza weprostate ufunyenwe ngengozi kwizicwili ezisusiweyo ukuze kwandiswe iprostate ngendlela engeyiyo
- Ukunyuka kwe-PSA ngexesha lokuhlolwa, okubangela ukuba kuphindwe okanye kujongwe i-biopsy
I-Biopsy ayizenzekeli kwi-PSA nganye ephakanyisiweyo. Usulelo lomchamo, ukuxinwa kwe-catheter kutshanje, i-prostatitis, ukuphuma komchamo kutshanje kunye nokukhula okungengobungozi konke oku kunokunyusa i-PSA. Nokuba i-biopsy sisigqibo esenziwa ngumntu ngamnye esilinganisa ubudala, ezinye izifo kunye nobude bobomi.
Oko amanqaku eGleason angenakukwazi ukukubona okanye ukungakubandakanyi
- Ayikuxeleli iqonga. Udidi luchaza inkangeleko yeseli kuphela. Nokuba umhlaza ufikelele kwi-capsule, kwi-seminal vesicles, kwi-lymph nodes okanye kwithambo kuvela kuvavanyo, kwi-MRI, kwi-PSMA PET okanye kwi-bone scan.
- Ayilinganisi ukuba ungakanani umhlaza okhoyo. Ubude be-core obubandakanyekayo kunye nenani le-positive cores zixelwa ngokwahlukeneyo kwaye zibalulekile.
- Amanqaku aphantsi eGleason awayikhuseli umhlaza wezinga eliphezulu kwezinye iindawo kwiprostate. Iisampulu ze-biopsy yenaliti kwinxalenye encinci ye-gland. Ukuphuculwa kwenkqubo yotyando kuyaziwayo.
- I-biopsy engeyongozi ayikhuseli umhlaza we-prostate. "Akukho mhlaza ufunyenweyo" uchaza izicubu ezithathwe isampuli, kungekhona i-prostate yonke. Ukuba i-PSA iyaqhubeka nokunyuka okanye iimpawu ziyaqhubeka nangona kwenziwe i-biopsy eqhelekileyo, buyela kwi-urologist yakho.
- Ayigubungeli yonke i-prostate cancer. Ukuhlolwa kweGleason kusebenza kwi-acinar adenocarcinoma. Umhlaza we-prostate omncinci okanye i-neuroendocrine awulinganiswanga ngokweGleason kwaye uziphatha ngendlela eyahlukileyo.
- Ayixeli kwangaphambili isiphumo somntu ngamnye. Inqaku likaGleason litshintsha amathuba; alibikezeli indlela umntu omnye aza kuphumelela ngayo.
- Ayibonisi impendulo yonyango okanye umngcipheko wemfuza. Uvavanyo lwe-germline, izixhobo zokwahlulahlula i-genomic kunye nemifanekiso ziphendula imibuzo eyahlukeneyo.
Iimviwo ezinxulumeneyo kodwa ezahlukeneyo
| uvavanyo | Yibuze iyaphendula | Oko ingenakukwenza |
|---|---|---|
| Amanqaku eGleason / Iqela leBanga | Zibonakala zingaqhelekanga kangakanani iiseli zomhlaza? | Ayikwazi ukubonisa indawo, ubungakanani okanye ukusasazeka kwayo |
| Uvavanyo lwegazi lwePSA | Ngaba kukho uphawu lwe-biochemical olufuna uvavanyo olongezelelweyo? | Ayisiyonto ihambelana nomhlaza; inokukhuliswa lusulelo okanye ukukhula, kwaye inokuba yinto eqhelekileyo xa kukho umhlaza |
| Uviwo lwe-Digital rectal | Ingaba i-gland ayilunganga okanye iqinile ngasemva? | Akayifumani i-tumor yangaphambili nencinci |
| I-MRI ye-Multiparametric (PI-RADS) | Ngaba kukho isilonda esifanelekileyo ukujoliswa kuso kwi-biopsy? | Ukurhanelwa komfanekiso akulophawu; i-MRI ayinakunika amanqaku eGleason kwaye inokuphoswa zezinye iintlobo zomhlaza, kuquka nezinye ezikumgangatho ophezulu. |
| Isigaba se-TNM | Umhlaza uye wanda kangakanani? | Akukho nto ayithethayo malunga nokubonakala kweseli |
| I-PSMA PET-CT / iskeni yamathambo | Ngaba kukho ukusasazeka ngaphaya kweprostate? | Ayizichazi izicubu; kuvela izinto ezilungileyo nezingalunganga ezingezizo |
| Uvavanyo lwe-genomic classifier | Ulwazi olongezelelweyo lomngcipheko we-molecular | Ukufumaneka okulinganiselweyo; ayithathi indawo yokubeka amanqaku |
Udidi oluvela kwi-biopsy yenaliti kunye nodidi oluvela kwi-prostate esusiweyo nazo zahlukile. Udidi lwe-prostatectomy lubonisa yonke i-gland kwaye lolona vavanyo lupheleleyo; lunokuba phezulu okanye ngaphantsi kunodidi lwe-biopsy.
Ukulungiselela
Akukho lungiselelo lweGleason score ngokwayo, lwenziwa kwilebhu. Ulungiselelo lusebenza kwi-biopsy. Iiprotokholi zahlukile kakhulu phakathi kwezibhedlele kunye neendlela ezichanekileyo nezingenasibeleko. Imiyalelo ebhaliweyo yeyunithi yakho ibaluleke ngaphezu kwayo nayiphi na into apha.
- Amachiza: Xelela iqela nge-aspirin, i-clopidogrel, i-warfarin, i-apixaban, i-rivaroxaban, i-dabigatran kunye nayo nayiphi na imithi yesintu okanye ye-AYUSH. Musa ukuyeka okanye ukutshintsha naluphi na unyango olunikiweyo ngokwakho, ugqirha onika amayeza okanye iqela le-urology liya kucebisa.
- amachiza: Iiyunithi ezininzi zinika uthintelo lokubulala iintsholongwane, ingakumbi kwi-transrectal biopsy. Iindlela zokusetyenziswa ziyahluka ngokweepateni zokumelana nendawo.
- Ukulungiswa kwamathumbu: Ezinye iiyunithi zisebenzisa i-enema ngaphambi kokuba kuthathwe i-transrectal biopsy; ezinye azisebenzisi.
- Ukuzila ukudla: ifuneka kuphela ukuba kucetywayo ukuthomalalisa okanye i-anesthesia ngokubanzi, into eqhelekileyo kwi-biopsy ye-transperineal.
- Ukuhlolwa kosulelo: Usulelo olusebenzayo lomchamo ludla ngonyango ngaphambi kokuba kuthathwe i-biopsy.
- Zothutho: lungiselela umntu ukuba akukhaphe ukuba usebenzisa isithomalalisi.
Amadoda anesifo seswekile asebenzisa unyango lokunciphisa iswekile
Ukuba kufuneka uzile ukutya, buza ugqirha wakho kwangaphambili ukuba ungayiphatha njani i-insulin okanye i-sulfonylureas ngaloo mini. Ukuzila ukutya ngaphandle kolwalathiso kula mayeza kunokubangela ukuba umntu angabi naswekile egazini.
Amadoda anesifo sezintso esingapheliyo okanye ukungasebenzi kakuhle kwentliziyo
Xelela iqela ngaphambi kokuba ucinge ngemifanekiso enokusebenzisa umahluko, nangaphambi kokuba ucelwe ukuba usele amanzi amaninzi emva kwenkqubo. Imiyalelo yolwelo ingadinga ukulungiswa.
Abantu abadala kunye namadoda asebenzisa amayeza amaninzi
Xoxani ngokuba i-biopsy iya kutshintsha na ulawulo. Kumadoda anobomi obulinganiselweyo okanye ubuthathaka obukhulu, umonakalo unokuba ngaphezu kolwazi olufunyenweyo.
Amadoda asebenzisa amayeza okuthintela ukugabha kwegazi
Umngcipheko wokopha uphezulu. Isigqibo sokumisa, ukuvala okanye ukuqhubeka nokuthintela ukujiya kwegazi sithathwa ngumntu ngamnye kwaye kufuneka sivele kwiqela elinyangayo.
Kwenzeka ntoni ngexesha lenkqubo
I-biopsy. Kusetyenziswa isikhokelo se-ultrasound, sidla ngokudityaniswa nemifanekiso ye-MRI yangaphambili. I-local anaesthetic iyafakwa. Kuthathwa ii-cores ezininzi, ngokuqhelekileyo iseti ecwangcisiweyo kunye nee-cores ezijoliswe kuyo nayiphi na i-MRI lesion. I-sampling ngokwayo idla ngokuthatha malunga nemizuzu eli-10 ukuya kwengama-20; ngokungeniswa, imvume, i-anesthesia kunye nokuchacha, kulindeleke ukuba ihlale esibhedlele iiyure ezimbalwa. I-transperineal biopsy phantsi kwe-sedation okanye i-anesthesia ithatha ixesha elide.
Inqanaba lelebhu. Ii-cores ziyalungiswa, zicutshungulwe zibe yiparafini, zihlulwe zibe ziinxalenye kwaye zidaywe. Ingcali yezifo ihlola i-core nganye, ichonge umhlaza, inike iipateni kwaye ibale amanqaku kunye neQela leBanga. I-immunohistochemistry ingongezwa xa inkangeleko ingacacanga, nto leyo eyongeza ixesha. Iingxelo zihlala zilungile kwiintsuku ezimbalwa zokusebenza; uphononongo lweengcali okanye ukudluliselwa kweeslayidi kongeza ezinye iintsuku.
Ukuqonda ingxelo yakho
Ingxelo ye-prostate biopsy idla ngokuquka okungaphezulu kwenqanaba.
- Inqaku likaGleason libhalwe njengesibalo: umzekelo 3+4=7, kunye neQela leBanga.
- Inani lee-cores ezibandakanyekayo kwinani lilonke elithathiweyo, ngokwendawo nganye.
- Ipesenti okanye ubude besiseko ngasinye esichaphazelekayo ngumhlaza.
- Ipesenti yepateni 4 kwisifo seGleason 7, esichaphazela izigqibo zokubeka esweni.
- Ukuhlasela kwePerineural, ulwandiso olungaphandle kweprostati okanye ukubandakanyeka kwe-seminal vesicle ukuba kubonwe.
- I-Cribriform okanye i-intraductal carcinoma, zombini zithathwa njengeempawu ezimbi.
- Iziphumo ezingezizo zomhlaza njenge-high-grade prostatic intraepithelial neoplasia (HGPIN) okanye i-atypical small acinar proliferation (ASAP), ezingezizo umhlaza kodwa zinokukhokelela ekulandelelweni.
Akukho ngxelo izichazayo. Inqanaba kufuneka lifundwe kunye ne-PSA, uvavanyo, imifanekiso, ubudala bakho kunye nezinye iimeko zempilo yakho ngugqirha wezifo zomchamo okanye ugqirha wezifo zomchamo olawula unyango lwakho.
Ukungaqondani okuqhelekileyo malunga neGleason 6
Amadoda amaninzi afunda "6 kwi-10" njengophakathi. Lelona banga liphantsi elixeliweyo kwi-biopsy. Umhlaza weBanga loku-1 awufane udlule kwi-metastases, kwaye ukubekwa esweni okusebenzayo lukhetho oluqhelekileyo, oluxhaswa yisikhokelo endaweni yokungahoywa. Ukubekwa esweni kubandakanya uvavanyo lwe-PSA olucwangcisiweyo, uviwo, i-MRI kunye ne-biopsy ephindaphindwayo.
Xa amanqaku eGleason enokukhohlisa
Xa ibakala lisenokuba liphantsi ngokungeyonyani (umgangatho ophantsi)
- Inaliti ayikwazanga ukujolisa kakhulu, umda owaziwayo wokuthatha isampuli yomthamo omncinci wamadlala.
- I-biopsy ecwangcisiweyo ngaphandle kokujoliswa kwi-MRI, edla ngokungayifumani i-tumor yangaphambili.
- Zimbalwa kakhulu ii-cores ezithathiweyo, okanye ii-cores ezithathiweyo kwindawo enye kuphela.
- Umhlaza omncinci embindini, nto leyo eyenza kube nzima ukuvavanya ipateni.
Xa umgangatho usenokuba phezulu ngokungeyonyani (ugqithiso)
- Iimpawu ezingezizo ezibonisa umhlaza ezifana ne-adenosis, i-atrophy okanye i-partial atrophy ayiqondwa kakuhle njengeepateni zomhlaza.
- Isixhobo esenziwe ngoyilo lwe-gland olujijekileyo okanye olunganyakazi kakuhle.
- Utshintsho lwezicubu emva konyango lwe-radiotherapy okanye unyango lokuncitshiswa kwe-androgen, ukuhlelwa kweGleason akujongwa njengokusebenza kwizicubu ezinyangiweyo kwaye kufanele kuphawulwe ngolo hlobo.
- Ukuhlukaniswa kwe-tangential okudala umbono ongeyonyani wee-fused glands.
Umahluko phakathi kweengcali zezifo
Ukubeka amanqaku kukugweba okubonakalayo. Imvumelwano phakathi kweengcali zezifo ilungile kodwa ayiphelelanga, ingakumbi kumda we-3 ngokuchasene no-4 owahlula iQela leBanga loku-1 kwiQela lesi-2 leBanga. Loo mda mnye udla ngokugqiba phakathi kokubekwa esweni kunye nonyango. Uluvo lwesibini lwengcali ye-uropathology ngaphambi kokuba izinikele kunyango olukhulu sisicelo esifanelekileyo kwaye siyinto eqhelekileyo.
Iingozi kunye nokhuseleko
Inqaku leGleason ngokwalo alinawo umngcipheko womzimba. Umngcipheko ungowe-biopsy eyenze izicubu, kwaye zahlukile ngendlela ezisebenza ngayo.
I-biopsy ekhokelwa yi-transrectal ultrasound
Igazi elikwimchamo, kwimbewu kunye nendle liqhelekile kwaye lihlala lihlala iintsuku ukuya kwiiveki. Igazi elikwimbewu linokuhlala iiveki ezininzi. Eyona ngxaki iphambili lusulelo, kubandakanya usulelo lomchamo kunye ne-sepsis, kuba inaliti idlula eludongeni lwe-rectal. Ukwanda kokuxhathisa ii-antibiotic kwenze oku kwaba yinto ebalulekileyo eIndiya. Ukugcinwa komchamo kunokwenzeka.
Transperineal biopsy
Inaliti idlula eluswini lwe-perineal kune-rectum, kwaye iingxaki zosulelo zihlala ziphantsi. Ukopha, ukukrweleka, iintlungu ze-perineal kunye nokugcinwa komchamo kusenzeka, kwaye i-anesthesia okanye i-sedation ineengozi zayo.
Iingozi zolwazi ngokwalo
Ukufumanisa umhlaza okumgangatho ophantsi ongazange ubangele ingozi kunokukhokelela kunyango olunemiphumo emibi ehlala ixesha elide yomchamo kunye neyesondo. Yiyo loo nto ukubekwa kwinqanaba kunye nokwenza izigqibo okwabelwana ngazo kubalulekile njengokuhlolwa kwe-biopsy.
Iiflegi ezibomvu emva kwe-prostate biopsy
Ingxamiseko: funa unyango ngoku
- Umkhuhlane oquka ukuqhaqhazela, ukuziva ungaphilanga kakuhle, ukudideka, ukuphefumla ngokukhawuleza, okanye ukubetha kwentliziyo okukhawulezayo, mhlawumbi i-sepsis
- Ukungakwazi ngokupheleleyo ukuchama kunye nesisu esisezantsi esibuhlungu nesivuvukileyo
- Ukopha kakhulu kwi-rectum okanye kumchamo kunye namahlwili, isiyezi okanye ukuphelelwa ngamandla
Ngosuku olufanayo: nxibelelana neqela lakho le-urology namhlanje
- Ubushushu obungaphezulu kwesiqhelo ngaphandle kwezinye iimpawu ze-sepsis
- Ukutsha xa uphuma umchamo ngokuphindaphindiweyo nangokungxamisekileyo
- Intlungu eyandayo endaweni yokuba ihlale ixesha elide
- Igazi elibonakalayo elihlala lihleli kumchamo ngaphaya kwexesha elicetyisiweyo yiyunithi yakho
Isiqhelo: bhukisha idinga
- Igazi elikwisidoda lihlala iiveki ezininzi ngaphandle kwezinye iimpawu
- Ubuhlungu obuncinci be-perineum okanye i-rectal obuphucuka kancinci kancinci
- Imibuzo malunga nebanga lakho, iqela leBanga okanye amanyathelo alandelayo
Iimeko ezikhethekileyo
Abantu abadala abadala
Umgangatho utolikwa ngokuchasene nobude bobomi kunye nokugula okuhambisana noko. Umgangatho ophezulu kwindoda ephila ixesha elide elilindelweyo udla ngokubangela unyango olusebenzayo; umgangatho ofanayo kwindoda enesifo esikhuphisanayo esinzima unokulawulwa ngonyango lweehomoni okanye ngoqwalaselo.
Amadoda abekwe esweni ngokukhutheleyo
I-biopsy ephindaphindwayo okanye i-MRI icwangciselwe ukubona inkqubela phambili yamanqaku. Ukunyuka okubonakalayo kwamanqaku kunokubonisa isampuli engcono kunotshintsho lokwenyani lwebhayoloji.
Emva kwe-radiotherapy okanye unyango lwe-hormone
Unyango lutshintsha inkangeleko yeseli. Ukuhlelwa kweGleason okuqhelekileyo akusebenzi kwizicubu ezinjalo, kwaye iingxelo kufuneka zichaze oku ngokucacileyo.
Amadoda anesifo sezintso esinganyangekiyo okanye akwi-dialysis
Ukukhetha amayeza okubulala iintsholongwane kunye nedosi ngaphambi kokuba kuthathwe i-biopsy, kunye nokusetyenziswa komahluko kwimifanekiso yesigaba, kufuneka kulungiswe. Xelela iqela ngalinye elibandakanyekayo malunga nokusebenza kwezintso zakho.
Amadoda anembali yosapho eqinileyo okanye uhlobo lwe-BRCA2 olwaziwayo
Ukutolikwa kwamanqanaba akutshintshi, kodwa iingcebiso ngemfuza kunye novavanyo lwe-germline zinokucetyiswa, kwaye oku kunokuchaphazela ukubekwa esweni kwizalamane kunye neendlela zonyango kamva.
Inqaku likaGleason kumxholo waseIndiya
- Intetho eyenzeka kamva yingongoma ephindaphindwayo. Uthotho lwezibhedlele zaseIndiya lubike ngokuphindaphindiweyo inani eliphezulu lomhlaza weprostate okwinqanaba eliphezulu nowe-metastatic ekuxilongweni kokuqala kunakumazwe anovavanyo lwe-PSA oluxhaphakileyo. Ngoko ke, amanqaku aphezulu eGleason ekuxilongweni abonisa iipatheni zokubonakaliswa kunye nebhayoloji.
- Isigama: Izigulane kunye neeklinikhi zihlala zisithi "ingxelo ye-prostate biopsy", "uvavanyo lwe-PSA" kunye ne "TRUS biopsy". Ibanga linokucatshulwa njengo-"3+4" ngaphandle kweQela leBanga, cela zombini.
- Ukunganyangeki kwii-antibiotics iye yaqhuba amaziko amaninzi aseIndiya ukuba asebenzise i-transperineal biopsy kunye nokuthintela ukukhulelwa okujoliswe kwinkcubeko. Indlela yokusebenza iyahluka kakhulu phakathi kwezibhedlele.
- Ubuchule be-Uropathology bugxile kakhulu kwiindawo ezinkulu. Ukuba i-biopsy yakho ibikwe kwilabhoratri encinci kwaye kucetywa utyando olukhulu, xoxa ngophononongo lweslayidi nogqirha wakho womchamo. Iibhloko kunye neeslayidi zihlala zinokufunyanwa kwaye zithuthwe.
- Gcina iislayidi zakho kunye neebhloko zilandeleka. Qaphela igama lelebhu kunye nenombolo ye-histopathology; uza kuzifuna nakweyiphi na ingcebiso yesibini okanye unyango kwesinye isibhedlele.
Ixabiso kunye ne-inshurensi eIndiya
Inqaku leGleason alihlawuliswa ngokwahlukeneyo. Ixabiso lixhomekeke kwintlawulo ye-histopathology yesampuli ye-prostate biopsy, eyinxalenye yeendleko zenkqubo ye-biopsy. Iindleko zahlukile kakhulu phakathi kukarhulumente, i-trust kunye nezibhedlele zabucala kunye naphakathi kwezixeko, ngoko cela uqikelelo olubhaliweyo ngaphambi kwenkqubo.
Izinto ezichaphazela imali oyihlawulayo:
- Indlela ye-Biopsy: i-transperineal biopsy phantsi kwe-sedation okanye i-anesthesia idla ngokubiza ngaphezulu kune-transrectal biopsy phantsi kwe-local anesthesia.
- I-MRI kuqala: I-MRI ye-multiparametric ngaphambi kwe-biopsy yongeza ixabiso elikhulu elahlukileyo.
- Inani lee-cores kunye neekhonteyina: I-histopathology idla ngokubiza ixabiso ngesitya ngasinye sesampuli.
- Immunohistochemistry okanye amabala akhethekileyo, ongezwe xa inkangeleko ingacacanga.
- Uphononongo lwesibini lwembono yeeslayidi kwilabhoratri yokudlulisela ulwazi.
- Indawo yokunyamekela emini xa kuthelekiswa nokwamkelwa esibhedlele, iindleko zengcali yokubulala iintlungu kunye neentlawulo zethiyetha yokusebenza.
- Ukuskena kwesiteji njenge-bone scan okanye i-PSMA PET-CT ukuba umgangatho uphezulu.
I-inshurensi: i-biopsy yokuxilongwa eyenziwa njengenkathalelo yasemini okanye ukwamkelwa idla ngokugutyungelwa yimigaqo-nkqubo ye-inshurensi yezempilo, kodwa uphando lwezigulane ezingalaliswanga ekhaya alugutyungelwa rhoqo. Ukhuseleko luxhomekeke kwimigaqo-nkqubo yakho yepolisi, amaxesha okulinda kunye nezigaba zesifo esele zikhona. Qinisekisa kwidesika ye-inshurensi yesibhedlele kunye nomshwalense wakho ngaphambi kwenkqubo. Iinkqubo zikarhulumente kuquka u-Ayushman Bharat PM-JAY zigubungela ukuxilongwa komhlaza kunye neephakheji zonyango kwizibhedlele ezilungisiweyo; iinkcukacha zokufaneleka kunye nephakheji kufuneka zihlolwe kwindawo yakho.
Iintsomi nezibakala
| Inkolelo | inyaniso |
|---|---|
| Inqaku leGleason eli-6 lithetha umhlaza ophakathi | IGleason 6 yiGrade Group 1, eyona grade iphantsi exeliweyo kwi-biopsy. Isikali esisetyenziswayo ngoku siqala kwi-6 ukuya kwi-10. |
| I-biopsy engeyongozi ithetha ukuba akukho mhlaza | I-biopsy ichaza isampuli yezicubu ezithathwe kwisampuli. Umhlaza kwenye indawo kwi-gland ungaphoswa. Ukulandelela okuqhubekayo kwe-PSA kuyinto eqhelekileyo. |
| U-3+4 kunye no-4+3 ziyafana kuba zombini zongeza kwi-7 | I-oda ibalulekile. I-4+3 inepatheni ephezulu kakhulu kwaye ngokubanzi inengozi enkulu. |
| I-Gleason 10 ithetha ukuba akukho nto inokwenziwa | Inqanaba eliphezulu libonisa isifo esinobundlongondlongo, kungekhona isiphumo esisisigxina. Kukho iindlela zonyango kwaye iziphumo ziyahluka ngokweemeko zomntu ngamnye. |
| Inqaku likaGleason likuxelela ukuba umhlaza usasazekile na | Udidi luchaza inkangeleko yeseli kuphela. Ukusasazeka kuvavanywa ngokuhlolwa kunye nemifanekiso. |
| I-PSA ephezulu isoloko ithetha amanqaku aphezulu eGleason | I-PSA kunye ne-grade zizinto ezahlukeneyo zokulinganisa. Umhlaza okumgangatho ophezulu unokwenzeka xa une-PSA encinci, kwaye ukwanda okungengobungozi kunokunyusa i-PSA kakhulu. |
| Ibanga le-biopsy lelokugqibela | Umgangatho kwi-prostate esusiweyo unokwahluka kumgangatho we-biopsy, kwaye umgangatho unokuvavanywa kwakhona kwi-biopsy ephindaphindwayo ngexesha lokujonga. |
Imibuzo ebuzwa qho
Ngaba kukho amanqaku aqhelekileyo eGleason?
Hayi. Amanqaku eGleason anikwa kuphela xa umhlaza ufunyenwe kwizicubu zeprostate. I-biopsy engenamhlaza ayinamanqaku eGleason kwaye ayisiyo "Gleason 0" okanye "Gleason 2". Amanqaku amadala ukusuka kwi-2 ukuya kwi-5 awasanikwa kwi-needle biopsies kuba ezo patheni zibonakalise ukungathembeki kwaye zihlala zimela izicubu ezingengobungozi.
Kuthatha ixesha elingakanani ukufumana amanqaku eGleason emva kovavanyo lwe-biopsy?
Izicubu zifuna ukulungiswa, ukucutshungulwa, ukuhlulwahlulwa, ukudaywa kunye nokufundwa ngobuchule. Uninzi lweeyunithi zibika kwiintsuku ezimbalwa zokusebenza. Amabala angaphezulu e-immunohistochemical, imeko enzima, okanye ukudluliselwa kweeslayidi ukuze ufumane uluvo lweengcali ze-uropathology kuya kongeza ixesha. Buza iqela lakho le-urology ukuba ingxelo yakho ilindelwe nini kwaye iza kudluliselwa njani.
Ngaba amanqaku eGleason angatshintsha?
Amanqaku esampuli ethile awatshintshi, kodwa isampuli yamva nje inokwahluka. Ukuphinda i-biopsy ngexesha lokujonga okanye ukuvavanya i-prostate esusiweyo kunokubonisa umgangatho ophezulu okanye ophantsi. Oku kudla ngokubonisa ukusampula okungcono kwe-gland kunokuba umhlaza utshintshe.
Ngaba kufuneka ndifumane uluvo lwesibini kwiislayidi zam ze-biopsy?
Kufanelekile, ingakumbi xa ibakala likwindawo ephakathi kweBanga le-1 nele-2, xa kucwangciswa utyando olukhulu okanye unyango lwe-radiotherapy, okanye xa ingxelo ingacacanga. Iislayidi kunye neebhloko zeparafini zinokufunyanwa kwilabhoratri yokuqala kwaye zithunyelwe ukuze kuhlolwe ingcali ye-uropathology.
Yintoni umahluko phakathi kwamanqaku eGleason kunye neQela leBanga?
Zombini zichaza izicubu ezifanayo. Inqaku leGleason liyimbumba yeepateni, ukusuka kwi-6 ukuya kwi-10. Iqela leBanga liguqula oku kube yi-1 ukuya kwi-5, lahlula u-3+4 ku-4+3, kwaye liphepha ingcamango ekhohlisayo yokuba u-6 uphakathi. Iingxelo zangoku kufuneka zichaze zombini.
Ngaba iGleason 6 isoloko ifuna unyango?
Akunjalo ngokuyimfuneko. Amadoda amaninzi anesifo seBanga loku-1 anikwa uhlolo olusebenzayo, kunye novavanyo olucwangcisiweyo lwe-PSA, uvavanyo, i-MRI kunye ne-biopsy ephindaphindwayo. Isigqibo sikwalinganisa inani lee-cores ezilungileyo, inqanaba le-PSA, iziphumo ze-MRI, ubudala kunye nokukhetha kwakho. Xoxa ngeenketho nogqirha wakho womchamo endaweni yokucinga ngenye indlela.
Ngaba i-MRI ingandinika amanqaku eGleason ngaphandle kwe-biopsy?
Hayi. I-MRI inika udidi lokurhanelwa kwe-PI-RADS kwaye ikhokela apho kufuneka i-biopsy khona. Ukubeka amanqaku kufuna izicubu ezihlolwe phantsi kwe-microscope. I-MRI ayinakuyisusa ngokuthembekileyo umhlaza; i-MRI engalunganga iyanciphisa kodwa ayisusi amathuba okuba nesifo esibalulekileyo ngokwezonyango.
Kutheni ingxelo yam ikhankanya i-cribriform okanye i-intraductal carcinoma?
Ezi ziipateni ezithile zokwakha ezibonwa njengeempawu ezimbi. Ubukho bazo bunokuchaphazela ukuba ukubekwa kweliso okusebenzayo kuyanikezelwa kwaye bunokukhuthaza unyango olunzima okanye ukulandelelana okusondeleyo, nokuba kukwinqanaba elifanayo leGleason. Buza ugqirha wakho wezifo zomchamo ukuba ezi ziphumo zichaphazela njani isicwangciso sakho esithile.
Kuza kuhlolwa kangaphi amanqaku am eGleason?
Akukho xesha limiselweyo. Amadoda abekwe esweni ngokusebenzayo avavanywa ngokuphindaphindiweyo kwishedyuli ebekwe liqela lawo, ngesiqhelo edibanisa i-PSA, uviwo, i-MRI kunye ne-periodic repeat biopsy. Amadoda afumene unyango adla ngokulandelwa nge-PSA kunye ne-imaging endaweni yokuphinda abekwe amanqaku.
imithombo
- Ulwahlulo lweeTumours lwe-WHO: IiTumours zeSiniti kunye nezeSiniti zamadoda, i-International Agency for Research on Cancer.
- Iingqungquthela ze-International Society of Urological Pathology (ISUP) malunga nokuhlolwa kwe-Gleason ye-prostate carcinoma, kuquka neengxelo ze-2014 kunye ne-2019.
- U-Epstein JI et al., inkqubo yeGleason yanamhlanje kunye nenkqubo yeGrade Group, epapashwe kwi-American Journal of Surgical Pathology and European Urology.
- Izikhokelo ze-European Association of Urology kwi-Prostate Cancer.
- Izikhokelo zeNational Cancer Network Clinical Practice kwi-Oncology: Umhlaza weProstate.
- IBhunga laseIndiya loPhando lwezoNyango - iZiko leSizwe leeNkcukacha zoLwazi lweZifo noPhando, iingxelo zeNkqubo yeSizwe yoBhaliso loMhlaza.
- Iprotokholi yeKholeji yeengcali zePathology zaseMelika yokuhlolwa kwe-prostate needle biopsy kunye neesampuli ze-radical prostatectomy.
