Early detection and early treatment are critical in decreasing Prostate cancer mortality. At present, the most excellent method for early detection of prostate cancer seems to be serum marker based screening. Given that early detection and appropriate treatment may do the most eradicate prostate cancer death, we started the mass screening for prostate cancer in Ohta district in Gunma prefecture in 1981 using the serum marker test, PAP. In 2003, 54 of 70 cities-towns-villages in Gunma prefecture conducted such screening, making it best in Japan. We have gotten several important results during the past 20 years. 1) PSA-based screening is the most appropriate system for prostate cancer mass screening. 2) Distincts that conduct screening definitively for the long time demonstrate a dramatic decrease in the proportion of stage D. 3) Survival in screened group is better than in the non-screened out-patient group. Our results assist those of Professor Bartch's group, that PSA-based screening decreased the mortality of prostate cancer in Tyrol, Austria. In the finale of my lecture, I surveyed and announced the main scientific papers from the department of Urology, Gunma University Graduate School of Medicine, during the last 5 years, related to prostate cancer mass screening and early detection of prostate cancer.

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Background and Aims : We report the results of clinical study into patients with bee sting, and two cases administrated rapid venom immunotherapy. Materials and Methods : A total of 245 patients with insect sting received medical treatment at Tone Central Hospital, Japan, between April 2001 and March 2003. Results : Forty eight patients experienced allergic symptoms of varying severity. Ten patients displayed grade IV anaphylaxy, no obvious correlations were identified between symptom severity and specific IgE-RAST values in response to insect venom. Rapid venom immunotherapy using long-legged wasp hymenoptera venom extract was administrated to 2 patients who displayed symptoms of shock. Maintenance dose (100μg/ml) was reached for 7 days without any adverse reactions. One of the 2 patients subsequently suffered bee sting again, but developed no symptoms of shock. Conclusion : venom immunotherapy is worth trying for patients displaying symptoms of shock following insect envenomation.

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Aims : We reported 5 cases of acute aortic dissection (AAD) and discuss appropriate preoperative management and surgical strategy. Patients : Subjects were 54 to 84 year old. Results : Three bad DeBakey type II dissection, one type II and, one type III b. Two of the 3 with type II dissection associated with cardiac tamponade underwent emergency surgery. One of the 2 was successfully operated on following pericardial drainage and another patient fell into cardiac arrest just before entering the operating room, resulting in postoperative death. One other patient with type II dissection died of re-rupture in spite of strict pressure control following pericardial drainage. Two other patients with type I or type III b dissection were treated conservatively during the acute phase. A patient with type III b dissection underwent operation the next day due to advancing renal impairment. Another with Type I dissection underwent operation successfully 2 months later. Conclusion : Rapid, precise diagnosis and treatment are indispensable for AAD. Immediate pericardial drainage is necessary for patients with cardiac tamponade, even in thrombosed-type dissection.

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Background and Aims : This study aims to identify what cancer patients motivate university hospitals to provide. Methods : Fifty-two cancer patients who visited the comprehensive medical department were interviewed and the results were analyzed. Results : Five categories were identified : 1. Consultation with regard to the appropriateness of the present diagnosis and treatment (30.8%), 2. Anxiety from appearance of new symptoms (30.8%), 3. Anxiety from insufficient improvement of symptoms (19.2%), 4. Hope for highly advanced medical treatment (9.6%) and 5. Hope for sufficient treatment and a warm atmosphere (9.6%). Conclusion : This study identified patients have anxiety from their conditions, treatments and appearance of new symptoms. Patients expect university hospitals to provide highly advanced medical treatment to them.

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Adrenal metastasis in lung cancer is often diagnosed, however, massive adrenal hemorrhage secondary to metastasis of lung cancer is extremely rare. We report here a case of massive adrenal hemorrhage secondary to metastasis of lung cancer. A 58-year-old man visited our emergency room complaining of sudden onset of severe left flank and back pain. Seven months before his admission, his lung cancer was diagnosed and chemotherapy with anti-cancer agents was given. Abdominal ultrasonography and computed tomography showed a solitary left adrenal tumor with massive hemorrhage (90 × 46mm). Laboratory findings showed anemia, however, acute adrenal failure could not be detected. Adrenal hemorrhage was carefully observed without surgery, because it was not progressive and a poor prognosis was predictable. The patient died from shock due to repeated massive hemorrhage about 2 months later. The signs and symptoms of massive adrenal hemorrhage are not specific, therefore, we should consider hemorrhagic adrenal metastasis in the differential diagnosis. Ultrasonography, CT, and MRI are quite useful in evaluation. Lung cancer patients with hemorrhagic adrenal metastasis have a dismal prognosis, and regaine careful consideration of the treatment for those with widely disseminated metastases.

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A 54-year-old type 2 diabetic woman had suffered from clouded vision indicating uveitis. Funduscopic examination showed retinal vein dilatation without diabetic retinopathy. Although urinalysis showed - to ± protein, the serum creatinine elevated. Urinary albumin excretion rate ; 29mg/g·creatinine and urine β2-microglobulin ; 9600μg/l reflected increased tubular protein excretion. Renal biopsy showed non-caseous granuloma with lymphocytic infiltration in the renal interstitium. It did not show diabetic nephropathy. The chest computed tomograms showed slightly peripheral granular shadow in bilateral lower lung fields. Pulmonary uptake of gallium-67 was positive. We diagnosed sarcoidosis accompanied by diabetes mellitus. The renal dysfunction may be caused by sarcoid granulomatous interstitial nephritis. We began giving her 40mg of methylprednisolone daily for renal involvement due to sarcoidosis. After blood glucose elevation, we then changed from glibenclamide to insulin therapy. The clouded vision subsequently recovered. Serum creatinine and urine β2-microglobulin returned to normal range.

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