Izindlela zokwelapha zeHormone vs. Non-Hormone ze-Advanced Prostate Cancer

-Delile

• Izindlela zokwelashwa zeHormone zomdlavuza we-Prostate advanced
• Isebenza kanjani i-hormone therapy?
• Ukwelashwa kwama-hormone okuvunyelwe
• Izinjongo zokwelashwa
• Zelashwa kanjani?
• Ngubani ozongenela ukhetho?
• Imiphumela emibi ejwayelekile
• Izindlela zokwelapha ezingezona ezomdlavuza womdlavuza wesibeletho othuthukile
• Ukwelashwa okuvunyelwe okungewona ama-hormone
• Izinjongo zokwelashwa
• Ngubani ozongenela ukhetho?
• Zelashwa kanjani?
• Imiphumela emibi ejwayelekile
• Okubalulekile

Uma umdlavuza wendlala yabesilisa ufinyelela esigabeni esithuthukile futhi amangqamuzana omdlavuza asabalalele kwezinye izingxenye zomzimba, ukwelashwa kuyisidingo. Ukulinda ngokuqapha akuseyona inketho, uma lokho bekuyinkambo yokwazi nodokotela wakho.

Ngenhlanhla, abesilisa abanomdlavuza we-Prostate osuthuthukile manje sebekhetha ukwelashwa okuningi kunanini ngaphambili. Lokhu kubandakanya zombili izindlela zokwelashwa kwama-hormone kanye nezinketho zokwelashwa okungezona ezama-hormone. Ukwelashwa okuqondile ozokuthola kuncike esigabeni sakho somdlavuza wendlala yesinye kanye nanoma yiziphi izimo ezingaphansi onazo. Khumbula ukuthi isipiliyoni sakho sokwelapha singahluka kakhulu kwesomunye umuntu.

Ukunquma ngokwelashwa, kuzodingeka ucabangele inhloso ephelele yokwelashwa, imiphumela yayo emibi, nokuthi ungumuntu ozobhapathizwa kahle noma cha. Ukwaziswa ngezindlela zokwelashwa ezitholakalayo kungasiza wena nodokotela wakho ukunquma ukuthi ikuphi ukwelashwa, noma inhlanganisela yokwelashwa, okungcono kakhulu kuwe.

Izindlela zokwelashwa zeHormone zomdlavuza we-Prostate advanced

Ukwelashwa kweHormone kwaziwa nangokuthi ukwelashwa kwe-androgen minimivation therapy (ADT). Kuvame ukuchazwa njengesihluthulelo sokwelashwa komdlavuza we-prostate we-metastatic.

Isebenza kanjani i-hormone therapy?

Ukwelashwa kweHormone kusebenza ngokunciphisa amazinga ama-hormone (androgens) emzimbeni. Ama-Androgens afaka phakathi i-testosterone ne-dihydrotestosterone (DHT). Lawa mahomoni akhuthaza umdlavuza wendlala yabesilisa ukuba wande. Ngaphandle kwama-androgens, ukukhula kwesimila kuyehla futhi umdlavuza ungaze ungene ekuxolelweni.

Ukwelashwa kwama-hormone okuvunyelwe

Kunezindlela zokwelashwa eziningana ezivunyiwe zomdlavuza we-prostate. Lokhu kufaka phakathi:

• Ama-agonists we-GnRH, afana ne-leuprolide (Eligard, Lupron) kanye ne-goserelin (iZoladex). Lokhu kusebenza ngokwehlisa inani le-testosterone elenziwa amasende.
• Ama-anti-androgens, afana ne-nilutamide (i-Nilandron) ne-enzalutamide (i-Xtandi). Lokhu kuvame ukungezwa kuma-agonists we-GnRH ukusiza ukuvimbela i-testosterone ekuhlanganiseni namaseli wesimila.
• Olunye uhlobo lwe-GnRH agonist olubizwa nge-degarelix (Firmagon), oluvimba amasiginali kusuka ebuchosheni kuya emasendeni ukuze kumiswe ukukhiqizwa kwama-androgens.
• Ukuhlinzwa ukukhipha amasende (orchiectomy). Empeleni, lokhu kuzomisa ukukhiqizwa kwamahomoni wesilisa.
• U-Abiraterone (Zytiga), umphikisi we-LHRH osebenza ngokuvimba i-enzyme ebizwa nge-CYP17 ukumisa ukukhiqizwa kwama-androgens ngamaseli emzimbeni.

Izinjongo zokwelashwa

Umgomo wokwelashwa kwehomoni ukuthethelelwa. Ukukhululwa kusho ukuthi zonke izimpawu nezimpawu zomdlavuza wendlala yesinye ziyahamba. Abantu abazuze ukuxolelwa "abelapheki," kepha bangahamba iminyaka eminingi ngaphandle kokubonisa izimpawu zomdlavuza.

Ukwelashwa kweHormone kungasetshenziselwa ukunciphisa ubungozi bokuphindeka ngemuva kokwelashwa kokuqala kwabesilisa abasengozini enkulu yokuphindeka.

Zelashwa kanjani?

Ama-agonists we-GnRH afakwa noma afakwa njengezinto zokufaka ezincane ngaphansi kwesikhumba. Ama-anti-androgens athathwa njengephilisi kanye ngosuku. UDegarelix unikezwa njengomjovo. Umuthi we-chemotherapy obizwa nge-docetaxel (Taxotere) kwesinye isikhathi usetshenziswa ngokuhlangana nalezi zindlela zokwelapha ama-hormone.

I-Zytiga ithathwa ngomlomo kanye ngosuku ihlanganiswe ne-steroid ebizwa nge-prednisone.

Ukuhlinzwa ukukhipha amasende kungenziwa njengenqubo yokwelashwa kweziguli. Kufanele ukwazi ukuya ekhaya emahoreni ambalwa ngemuva kwe-orchiectomy.

Ngubani ozongenela ukhetho?

Iningi labesilisa abanomdlavuza wesibeletho osezingeni eliphakeme bangabaqokelwe ukwelashwa ngamahomoni. Kuvame ukucatshangelwa lapho umdlavuza wendlala yabesilisa ususabalele ngalé kwendlala, futhi ukuhlinzwa ukuze kususwe isimila akusakwazi ukwenzeka.

Ngaphambi kokuqala ukwelashwa, kuzodingeka ukuthi uvivinye ukusebenza kwesibindi kanye nokuhlolwa kwegazi ukuze uqiniseke ukuthi isibindi sakho singayichitha kahle imithi.

Njengamanje, i-enzalutamide (i-Xtandi) ivunyelwe kuphela ukusetshenziswa emadodeni anomdlavuza wendlala yesinye esivele isabalele kwezinye izingxenye zomzimba, futhi engasasabeli ekwelashweni kwezokwelapha noma ngokuhlinzwa ukwehlisa amazinga e-testosterone.

Kwezinye izimo, amangqamuzana omdlavuza wendlala yesinye angamelana nokwelashwa kwamahomoni futhi ande noma engekho ama-hormone abesilisa. Lokhu kubizwa ngokuthi ngumdlavuza wendlala yesibindi ongazweli kuma-hormone (noma ovikela ukuthena). Amadoda anomdlavuza wendlala yesinye ongazweli kuma-hormone awavunyelwe ukwelashwa okwengeziwe kwama-hormone.

Imiphumela emibi ejwayelekile

Imiphumela emibi kakhulu yokwelashwa kwamahomoni ifaka:

• ukushisa okushisayo
• ukuncipha, amathambo aqhekekile (i-osteoporosis) ngoba amazinga aphansi e-testosterone adala ukulahleka kwe-calcium
• ukuzuza kwesisindo
• ukulahleka kwemisipha
• ukungasebenzi kahle kwe-erectile
• ukulahleka kocansi

Izindlela zokwelapha ezingezona ezomdlavuza womdlavuza wesibeletho othuthukile

Uma ukwelashwa kwe-hormone kungasebenzi noma umdlavuza wakho ukhula futhi usakazeka ngokushesha okukhulu, ukwelashwa ngezinye izinketho ezingezona ezama-hormone kunganconywa.

Ukwelashwa okuvunyelwe okungewona ama-hormone

Ukwelashwa okungewona ama-hormone komdlavuza wesibeletho osezingeni eliphakeme kufaka phakathi:

• I-Chemotherapy, efana ne-docetaxel (Taxotere), i-cabazitaxel (i-Jevtana), ne-mitoxantrone (i-Novantrone). I-Chemotherapy kwesinye isikhathi inikezwa ngokuhlangana ne-steroid eyaziwa ngokuthi i-prednisone.
• Ukwelashwa ngemisebe, okusebenzisa imishayo yamandla aphezulu noma imbewu enemisebe yokuqothula izicubu. Imisebe ivame ukusetshenziswa ngokuhlanganiswa ne-chemotherapy.
• I-Immunotherapy, kufaka phakathi i-sipuleucel-T (Provenge). I-Immunotherapy isebenza ngokusebenzisa amasosha omzimba uqobo ukubulala amangqamuzana omdlavuza.
• I-Radium Ra 223 (Xofigo), equkethe inani elincane lemisebe futhi isetshenziselwa ukubhubhisa amangqamuzana omdlavuza wendlala yesinye esenabele ethanjeni.

Izinjongo zokwelashwa

Inhloso yokwelashwa ngamakhemikhali, imisebe, nezinye izindlela zokwelapha okungezona ezamahomoni ukunciphisa ukukhula komdlavuza nokwelula impilo yomuntu. I-Chemotherapy namanye ama-non-hormone agents mhlawumbe ngeke akwazi ukwelapha umdlavuza, kepha angakwandisa kakhulu izimpilo zamadoda anomdlavuza we-prostate metastatic.

Ngubani ozongenela ukhetho?

Ungaba yilungu lokuthola ukwelashwa okungewona ama-hormone njenge-chemotherapy noma i-radiation uma:

• amazinga akho e-PSA akhula ngokushesha okukhulu ekwelashweni kwehomoni ukuyilawula
• umdlavuza wakho usakazeka ngokushesha
• izimpawu zakho ziya ngokuya ziba zimbi
• ukwelashwa kwamahomoni kwehluleka ukusebenza
• umdlavuza ususabalele emathanjeni akho

Zelashwa kanjani?

I-Chemotherapy ivame ukunikezwa ngemijikelezo. Umjikelezo ngamunye uvame ukuhlala amasonto ambalwa. Ungahle udinge imishanguzo eminingi yokwelashwa, kepha kuvame ukuba nesikhathi sokuphumula phakathi. Uma uhlobo olulodwa lwe-chemotherapy luyeka ukusebenza, udokotela wakho angancoma ezinye izinketho ze-chemotherapy.

I-Sipuleucel-T (Provenge) inikezwa njengokungeniswa okuthathu emthanjeni, cishe amasonto amabili phakathi kokumunyelwa ngakunye.

I-Radium Ra 223 nayo inikezwa njengomjovo.

Imiphumela emibi ejwayelekile

Imiphumela emibi ejwayelekile ye-chemotherapy ifaka:

• ukulahleka kwezinwele
• isicanucanu nokuhlanza
• isifo sohudo
• ukukhathala
• ukulahlekelwa isifiso sokudla
• amaseli egazi amhlophe aphansi (neutropenia) kanye nengozi ephezulu yokutheleleka
• izinguquko kwimemori
• ukuba ndikindiki noma ukuncinza ezandleni nasezinyaweni
• ukulinyazwa okulula
• izilonda zomlomo

Ukwelashwa ngemisebe kunganciphisa inani elibomvu lamaseli egazi lakho futhi kubangele ukushoda kwegazi. I-anemia ibangela ukukhathala, isiyezi, ikhanda, nezinye izimpawu. Ukwelashwa ngemisebe nakho kungaholela ekulahlekelweni kokulawulwa kwesinye (ukungasebenzi) kanye nokungasebenzi kahle kwe-erectile.

Okubalulekile

Izindlela zokwelapha ze-Hormone kanye nokuhlinzwa kuvame ukunconywa kuqala ukwelapha umdlavuza wesibeletho osezingeni eliphakeme. Zingasetshenziswa ngokubambisana ne-chemotherapy. Kepha ngemuva kwesikhathi esithile, umdlavuza omningi wesibeletho ungamelana nokwelashwa kwamahomoni. Izinketho ezingezona eze-hormone ziba yisinqumo esingcono kakhulu kwabesilisa abanomdlavuza we-prostate ongasaphenduli ekwelashweni kwama-hormone noma ekhemotherapy.

Noma ngabe kwelashwa, akuzona zonke izifo zomdlavuza wesibeletho osezingeni eliphakeme ezingalapheka, kepha izindlela zokwelapha zinganciphisa ukukhula komdlavuza, zinciphise izimpawu, futhi zenze ngcono ukusinda. Abesilisa abaningi baphila iminyaka ngomdlavuza wesibeletho osezingeni eliphezulu.

Ukwenza izinqumo mayelana nokwelashwa kungadida futhi kube yinselele ngoba kuningi okufanele ukubheke. Khumbula ukuthi awudingi ukwenza isinqumo wedwa. Ngokuholwa yi-oncologist yakho neqembu lezokunakekelwa kwempilo, ungenza isinqumo esinolwazi ngohlelo lokwelashwa olungcono kakhulu kuwe.