落合 厚

Atsushi OCHIAI

愛生会山科病院泌尿器科

Department of Urology,Aiseikai Yamashina Hospital

キーワード : prostate cancer, contrast-enhanced ultrasonography, elastography, intra-operative ultrasonography

経直腸的超音波検査は本邦で実用化され，前立腺癌のスクリーニング，浸潤度判定などに広く応用され，普及した．前立腺特異抗原（PSA）の発見と前立腺系統的針生検の開発により前立腺癌の早期診断が可能となった一方で，gray-scale法超音波検査の局在診断能は十分なものとは言えなくなり，その有用性はPSA容積補正のための前立腺容積測定や，系統的生検時の領域同定などに限定されている．新しい技術の進歩によりこれまで超音波で同定困難であった病変の局在診断が可能となれば，癌検出や治療の戦略が変わることが可能となる．近年，造影ドプラ検査，エラストグラフィが各領域において非侵襲的診断法として臨床応用されており，前立腺癌診断でもこれらの診断法を導入し，癌検出能の向上，新しい癌検出戦略の構築，治療への応用などが期待される．本稿では造影ドプラ法，エラストグラフィに関する最近の報告を紹介する．また，近年著しく進歩している経直腸的超音波による前立腺全摘術時の手術支援についても紹介する．

Transrectal ultrasonography (TRUS) of the prostate has been used for screening and staging of prostate cancer since the first practical tomogram of the prostate was obtained in Japan. Systematic biopsy of the prostate in men with elevated prostate specific antigen (PSA) has been a gold standard method for the detection of prostate cancer while the ability of conventional gray-scale imaging was limited to differentiating malignant from benign lesions. In this review, we discuss recent developments in TRUS. Contrast-enhanced Doppler imaging as well as elastography are new ultrasound technological modalities that improve cancer detection and may lead to new diagnostic approaches for prostate cancer. Furthermore, real-time TRUS navigation and augmented reality have been developed for minimally invasive surgery such as minilaparotomy and laparoscopic radical prostatectomy. Intra-operative TRUS visualizes the surgical anatomy and cancer lesion and may help surgeons perform precise operations. Recent advances in TRUS potentially improve the diagnostic performance and therapeutic outcome for prostate cancer.