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The prognosis for stage Ⅳ lung cancer is generally poor. However, there have been reports that local treatment of metastatic disease(that is oligometastatic disease), may improve prognosis. The standard treatment for stage Ⅳ non-small cell lung cancer with distant metastases is chemotherapy, and the efficacy of local therapy for primary tumors and metastases is controversial. In recent years, the efficacy of concomitant use of immune checkpoint inhibitor has also been reported, and it is possible that some evidence-based guidelines will be provided in the future. In this report, we describe a case of stage Ⅳ lung cancer with intra-abdominal lymph node metastasis that was treated with thoracoscopic and laparoscopic surgery, local radiation therapy, and chemotherapy. There have been no sign of recurrence for 1 year.

Lymphoepithelioma-like carcinoma (LELC) of the ureter is very rare and only 14 previous cases have been reported. Here, we report a case of LELC of the ureter. A 76-year-old woman was admitted to our hospital complaining of gross hematuria. Left ureteral cancer was suspected by the imaging examination, and laparoscopic left total nephroureterectomy was performed. Histopathological examination showed pure type of LELC in the ureter. She is alive without disease recurrence at fifteen months after surgery.

Neuronal intranuclear inclusion disease (NIID) is a neurodegenerative disease presenting with various manifestations including dementia, weakness, transient impaired consciousness, encephalitis-like episodes and also epileptic seizures. However, the nature of epileptic seizures, focal or generalized onset, remains unclear. A man at age 76 was admitted to a local hospital due to febrile impaired consciousness lasting several days. During the hospital stay, a generalized convulsion occurred, and afterward he remained obtunded. He was transferred to our hospital for further treatment. One additional seizure occurred while on an ambulance to our hospital and two additional seizures shortly after the arrival, which indicated convulsive status epilepticus (SE). The ictal EEG showed low amplitude fast activity arising from the left centro-parietal area with an evolutionary pattern. The clinical concomitant was the contralateral versive seizure evolving to a bilateral convulsion. Inter-ictal epileptiform abnormalities seen on the tracings taken on later days consisted of brief potentially ictal rhythmic discharges (B(I)RDs) and frequent sharp waves recorded from both frontal areas. These findings along with the ictal discharges would indicate a multifocal epileptic disorder in this patient. Diffusion weighted images (DWIs) of this patient showed hyperintensity signals in the cortico-medullary junctions in the bilateral frontal and the left parietal regions. Skin biopsy revealed characteristic intranuclear inclusions, and hence the diagnosis of NIID was made. The regions of epileptic foci on EEG corresponded well to the hyperintensity areas in DWIs, which suggests the cerebral cortices near the DWI hyperintensity could be more hyperactive than other regions. This case report suggests that some of the prolonged impaired consciousness and the encephalitis-like episodes in NIID could be related to epileptic seizures and even non-convulsive SE or a post-ictal twilight state after an unwitnessed convulsion. This issue should be further studied for the appropriate treatment of episodic encephalopathy and epileptic seizures in NIID.

Clinical Practice Guidelines are statements that include recommendations intended to optimize patient care. In the management of rheumatoid arthritis, many guidelines including ACR/EULAR recommendation, JCR guideline 2014 and number of JCR guidelines for each drug use have been published. The methodology to establish guidelines has been progressed, but work load for the guideline has become incredibly heavy. Legal position of guideline is also to be discussed.

The patient was a 33-year-old man attending the infertility clinic with primary infertility of 3 years duration. The semen examination showed oligozoospermia and suspected primary male infertility. He had a history of chronic sinusitis and respiratory disease. His chest X-ray showed dextrocardia. Abnormality of the ultrastructure of the cilia of the tract epithelium was found by electron microscopy, and further examination revealed bronchoectasis. We gave him a diagnosis of Kartagener syndrome from these findings. Kartagener syndrome consists of bronchiectasis, sinusitis and situs inversus and is considered a form of primary ciliary dyskinesia (PCD). PCD is also a cause of motor impairment of sperm flagella. This case had successful in-vitro fertilization pregnancy with spermatozoa from the patient.

Recently a concept of "sex differences" in medicine has been spreading. It is well known that autoimmune diseases, especially rheumatoid arthritis or systemic lupus erythematosus mostly affect women, and it is clear that there is a strong sex differences in many rheumatic diseases. Sex difference influences to progression or prognosis of the disease. Although the mechanisms of sex difference are not clear, the influence of sex hormones or sex chromosomes which gives immune system is partially elucidated. In addition, sex hormones may become the future new treatment target, and progress in the study regarding this event is expected in the future.

The etiology of shoulder-hand syndrome is as yet unknown. We hypothesized that it may be due to damaged unmyelinated fibers in front of the subscapular muscle. We examined the existence of edema and hypersensitivity to pain in the hands of stroke patients during the subacute stage and their relationships to cutaneous temperatures of the index fingertips in 75 hemiplegic patients (23 without edema, 32 with only edema, and 20 with edema plus allodynia). Patients were placed into two groups (comfortable and warm) depending on room temperature (22.2-25.6°C and 25.7-30°C, respectively). Of the patients with hand edema plus allodynia, 75% had a large lesion in the capsula, cortical white matter, and putamen. It was previously reported that the cutaneous temperature of the arm on the paralysis side of patients with lesions of the capsula or putamen was lower than that on the non-paralysis side. In the edema plus allodynia group, the temperature of the index fingertip on the affected side was higher than that of their contralateral fingers; the differences were smaller under warm conditions possibly due to blockade of the sympathetic nerves in the peripheral nerve. By contrast, in patients in the edema group, there were no differences in cutaneous temperatures of their two index fingers. Thus, it appears that patients with mild cases of shoulder-hand syndrome have conduction blocks in the posterior cord of the brachial plexus, while those with severe cases have both conduction blocks and neurogenic inflammation in both the lateral and posterior cords.

A 43-year-old man came to our clinic complaining of infertility and semen analysis showed azoospermia. Analysis of chromosomes showed a mosaic 45, XO/46, X, ＋mar1/46, X, ＋mar2 karyotype, and the marker chromosomes were considered to be two kinds of ring Y chromosomes. Y chromosome microdeletion analysis showed partial deletion of Azoospermic Factor (AZF) a, and complete deletion of AZFb and AZFc. The patient gave up having a child because these results indicated that no sperm would be collected even if Testicular Sperm Extraction (TESE) were performed.

We investigated 470 male patients who came to the Reproduction Medical Center of Yokohama City University Medical Center complaining of infertility between April 2,000 and August 2013. We analyzed the chromosomes of 90 patients whose sperm concentration was below 1.0 × 107/ml. Nineteen of the 90 (21.1%) patients showed sex chromosomal anomalies including 12 Klinefelter syndrome (47, XXY or 46, XY/47, XXY), Robertsonian translocation, 2 autosome-autosome translocation, Y-autosome translocation, 46, X with marker chromosome (46, Xmar⁺), XX male and Y chromosome macrodeletion (46, XYq-). While patients with chromosomal abnormalities except XX male or some of 46, XYq- may succeed in reproduction using testicular sperm extraction-intracytoplasmic sperm injection, we need to inform the patients about the risks of chromosomal abnormalities in the resulting fetus.

Disease-modifying antirheumatic drugs (DMARDs) have largely contributed to recent paradigm shift of rheumatoid arthritis (RA) treatment strategy. DMARDs can be indicated for all RA patients and early use of DMARDs after diagnosis of RA is recommended. Individual DMARDs have common characteristics. Understanding these characteristics is very important in treating RA. As for safety, the pattern of adverse reactions (ADRs) associated with DMARDs has been generally understood. It is necessary to select DMARDs and follow up patients with recognition of the pattern of ADRs. Regular monitoring is also essential to ensure the safety of DMARDs. This chapter deals with some major DMARDs in Japan, including methotrexate, which is indispensable in current RA treatment; salazosulfapyridine and bucillamine; tacrolimus, which is recently increasing in use; and iguratimod, which became available in 2012.

Chédiak-Higashi syndrome (CHS) is one of the primary immunodeficiency syndromes accompanied by oculocutaneous albinism. It is characterized by existence of giant granule of neutrophils, and development of symptoms of hemophagocytic lymphohistiocytosis. CHS is a rare disorder and recognition of the disease is indispensable for its diagnosis. In our case, a four-month-old boy, virus-associated hemophagocytic syndrome (VAHS) was suspected from generation of fever, hepatosplenomegaly, and existence of atypical lymphocytes on admission. However, elevation of serum AST, LDH and ferritin were quite slight as VAHS, and rapid exacerbation of the findings was not seen. Associated virus was undetected. He was finally diagnosed as CHS developing hemophagocyctic lymphohistiocytosis based on the existence of a giant granule of neutrophils in the peripheral blood smear and oculocutaneous albisum and laboratory findings. Clinical outcome was successful after receiving HLA-matched unrelated bone marrow transplantation.

Neuropathic pain syndromes are clinically characterized by spontaneous pain and evoked pain (hyperalgesia and allodynia). The optimal treatment approach for neuropathic pain is still under development because of the complex pathological mechanisms underlying this type of pain. The spinal cord is an important gateway thorough which peripheral pain signals are transmitted to the brain, and sensitization of the spinal neurons is one of the important mechanisms underlying neuropathic pain. Central sensitization represents enhancement of the function of neuronal circuits in nociceptive pathways and is a manifestation of the remarkable plasticity of the somatosensory nervous system after nerve injury. This review highlights the pathological features of central sensitization, which develops because of (1) injury-induced abnormal inputs from primary afferents, (2) increase in the excitability of dorsal horn neurons, and (3) activated glial cell-derived signals.

The primary goal in the treatment of rheumatoid arthritis (RA) is to maintain good quality of life by preventing joint destruction and avoiding disability. For this purpose, all patients with the diagnosis of RA should be treated by disease-modifying antirheumatic drugs (DMARDs) including biologic DMARDs and non-biologic DMARDs. All DMARDs are expected to prevent the progression of bone and cartilage destruction of RA patients from the results of in vitro research, and prevention of joint destruction is confirmed in vivo in all biologic DMARDs, but not in all non-biologic DMARDs. In this chapter, we would like to review the results of basic researches and clinical studies to demonstrate the prevention of joint destruction by non-biologic DMARDs that have been frequently used I daily practice.

We described a patient with secondary Sjögren's syndrome suspected showing multiple cranial neuropathies at the different time. A 68-year old woman has been treated as rheumatoid arthritis since 1963. In 2001, she was also diagnosed with Sjögren's syndrome suspected. Afterward, abducent and trigeminal neuropathies and uveites occurred. This case is important to insight into the cranial neuropathy with Sjögren's syndrome.

A case was presented of a 5-year-old girl who suffered an accidental dural puncture during placement of an epidural catheter under general anesthesia for orthopedic surgery. She complained of headache 4 days after the operation, which was relieved on supine position but became worse on sitting position. Her symptoms failed to respond to conservative management. An epidural blood patch was performed under general anesthesia and completely resolved her symptoms. The reported incidence of epidural blood patch for post dural puncture headache following accidental dural puncture in children is low. We outline this case and the consideration for management for epidural blood patch in pediatric patients.

Etiology of rheumatoid arthritis(RA) has not been clarified, however many candidate molecules for the target of RA treatment have been identified. Among those, regulation of TNF or IL-6 using antibodies or receptor molecules has brought a paradigm shift in the therapeutic strategy of RA and has become a standard therapy in daily practice. Many targeted therapy are now in the development for the treatment of RA, however, those target molecules are deeply involved in the immune function, and inhibition of these molecules may increase the susceptibility for infections. Also, using these expensive drugs for this chronic disease raises a pharmacoeconomical issue. There are many issues remaining to be solved.

Transfusion-related acute lung injury (TRALI) is a serious complication of transfusion of blood and blood components. TRALI is reported to be the most common cause of transfusion-associated death. TRALI has increasingly become known in the medical community. However, TRALI has been overlooked frequently because of poor knowledge of medical staffs. We report two cases of TRALI after massive transfusion due to massive bleeding during cardiovascular surgery. In the perioperative period, the diagnosis of TRALI is difficult to make because of coexistence of various factors leading to hypoxia. Thus, in this report, we discuss the management of these two cases focusing upon the differential diagnosis of TRALI.

Matrix metalloproteinase-3 (MMP-3) is a useful marker to evaluate the prognosis of joint destruction in rheumatoid arthritis (RA) . The role of MMP-3 in immune cells, however, remains to be elucidated in the pathogenesis of RA. On the other hand, biologic therapies, including tumor necrosis factor alpha (TNF-alpha) -blocking therapy, has been shown to reduce disease activity measures and joint damage progression ; however, the effects of biologic therapies on systemic osteoporosis remain to be elucidated in RA. In this article, we reviewed the literature on these issues after describing our hypothesis of the pathogenesis of synovitis in RA.

Myocardial ischemic preconditioning is a procedure giving powerful protection against myocardial ischemia and infarction. Clinical application of this property to anesthesia might improve anesthetic management of patients with cardiac diseases. Volatile anesthetics, including sevoflurane and isoflurane, can protect ischemic myocardium by activation of ATP-sensitive K channels (K(ATP)) and several clinical trials show that volatile anesthetics can prevent myocardial damage during operations compared with propofol, a popular intravenous anesthetic. Nicorandil is a potent K(ATP) opener and clinical application of nicorandil also can reduce myocardial damage during anesthetic management of patients undergoing off-pump CABG and patients with cardiac risks undergoing non-cardiac operations. In addition, diabetes mellitus and hyperglycemia may abolish the protective effect of preconditioning by impairing K(ATP). From point of view of clinical application of preconditioning, anesthetic maintenance with volatile anesthetics instead of intravenous anesthetics, such as propofol, and administration of nicorandil throughout perioperative period, is recommended to patients with heart diseases and control of blood glucose is useful to maintain the protective effect of preconditioning.

Guideline for the management of hyperuricemia and gout, first edition was published in 2002 from Japanese Society of Gout and Nucleic Acid Metabolism, and has contributed for the improvement in the management of patients by primary physicians. During five years after the publication of this first edition, large amount of evidences has been accumulated, thus it is time to revise the guideline. Japanese Society of Gout and Nucleic Acid Metabolism has organized the committee for the revision of guideline, and the operations have begun. In this revision, we pay attention to the quality in the process of guideline edition, application of AGREE checklist and patients perspective is considered.

Treatment of rheumatoid arthritis (RA) has been dramatically changed over the last few years mainly by the introduction of biologic agents. Several biologic agents have profound efficacy in patients with active RA, since these biologics target cytokines that is deeply involved in the pathogenesis of RA. The biologic agents have made it possible to inhibit the progression of structural damage and to introduce into remission. Because biologic agents are strong immunosuppressant and also quite expensive, questions arise whether it is possible to discontinue biologic agents in patients with good clinical response. No consensus has been established concerning this important clinical question until now, however, it may be possible to discontinue the injection in patients with early disease who successfully introduced into remission. In those patients with longstanding RA, even if patients are introduced into remission, it seems to be better to continue the biologics. In that case, it is recommended to try to discontinue concomitant corticosteroids or NSAIDs first, and then to reduce the dose of biologics, and finally to start considering the discontinuation of biologics.

A 77-year-old man underwent pylorus-preserving pancreatoduodenectomy for bile duct carcinoma in October 2000. Histological diagnosis was moderately-differentiated tubular adenocarcinoma, pT 2 (ss, pHinf 0, pPanc 1, pPV 0, pA 0), pN 0, and final Stage II. The patient was periodically observed after operation. In September 2003, follow-up abdominal CT examinations revealed a liver tumor, 89 x 62 x 60 mm in size, at the anterior segment. Transarterial chemoembolization with 5-FU, epirubicin, mitomycin C and superabsorbent polymer microsphere was initiated under the diagnosis of liver metastasis. After completion of 4 chemoembolizations, the tumor responded partially and diminished to 50 x 16 x 14 mm in CT and superparamagnetic iron oxide-enhanced MRI. Currently, the patient is free from any signs of relapse.

The prognosis of metastatic or recurrent GISTs is poor, because these tumors resist chemotherapy and radiotherapy. We report a patient with recurrent GIST who underwent molecularly targeted therapy with imatinib, a novel oral tyrosine kinase inhibitor. A 64-year-old man presented with large intra-abdominal mass. The patient had a history of jejunostomy with colostomy for intestinal GIST. The abdominal mass was phi3 x 3.5 cm in size with ascites at Douglas, as determined by computed tomography, and was diagnosed as a peritoneal relapse of GIST. Treatment with imatinib daily was started. After 1 month of treatment with imatinib, reduction of the abdominal tumor began to be recognized on palpation. Computed tomographic scanning at 11 months revealed that the tumor had completely disappeared. The major side effect was drug eruption,which was easily manageable with 2 weeks drug holidays. Imatinib shows promise as a safe and effective drug for the treatment of patients with recurrent GISTs.

The patient was a 78-year-old woman who underwent right hemicolectomy with lymph node dissection (D 2) for cecal cancer in June 2003. Histological diagnosis was moderately differentiated adenocarcinoma, ss, n(-), P 0, H 0, M (-), stage II. Adjuvant chemotherapy was not conducted, and the patient was periodically observed after operation. In April 2004, the serum CEA level was elevated to 14.9 ng/ml. Abdominal CT examinations revealed a tumor, 50 x 35 x 50 mm in size, on the right iliopsoas muscle close to the anastomotic site. Systemic chemotherapy with UFT + Leucovorin was initiated under the diagnosis of local recurrence. Only grade 1 body weight loss,pigmentation, pruritus, and anorexia were recognized during chemotherapy. However, these complications did not require administration. After completion of 6 courses of this chemotherapeutic regimen,the serum CEA level was normalized at 3.1 ng/ml, and CT scan revealed the tumor had disappeared in November 2004. Currently, the patient is free from any signs of recurrence and has maintained a complete remission (CR).

Because pneumonectomy causes a high-risk of perioperative mortality and morbidity, we have tried extended sleeve lobectomy (ESL) for patients with locally advanced lung cancer. The purpose of this study is to analyze the risk of complications and local relapses of ESL. Twelve patients underwent ESL, one-lobe and segment resection for 7, bi-lobe resection for 4, and bi-lobe and segment resection for 1. There was no hospital death. Two of 12 patients (17%) had an anastomosis complication. One (8%) had a staple line relapse. We conclude that ESL is a practicable technique for locally advanced lung cancer to avoid pneumonectomy.

The purpose of cancer screening is to widen the difference between morbidity and mortality of the target cancer. Since 1983 cancer screening has been supported by the Japanese government. Initially it covered gastric and cervical cancer with lung, breast and endometrial cancers supported from 1987 and colorectal cancer in 1992. Since 1998 support for cancer screening has been transferred to local government. It is generally accepted that the uptake of screening services is too low. Estimates for Japan suggest that at best 30% of the eligible population accept the services. In other parts of the world screening is more widely accepted, for example, 67% for breast cancer and 79% for cervical screening in the USA. Barriers within Japan for increasing screening are complex and include, legal, ethical, financial, technical infrastructure, data related matters and the level of understanding and education of the general public. In 2000 the MHLW conducted an evaluation of cancer screening in terms of usefulness and effectiveness. It concluded that fair or better evidence for reduction in mortality existed for cervical cancer (cytology), breast cancer (mammography with clinical examination for women aged > or = 50 years), colorectal cancer (faecal occult blood test), gastric cancer, lung cancer and liver cancer. As a step towards improving screening services and their uptake by the general public a new Research Centre for Cancer Prevention and Screening was established at the National Cancer Centre in October 2003. This and other initiatives will build on the progress of the past 20 years but it is generally agreed that there is still have a long way to go.

To evaluate the susceptibility of patient with focal interstitial pneumonia (IP) to postoperative acute exacerbation, and to determine whether measuring serum level of several markers is useful for early detection of postoperative IP or not, we analyzed a total of 753 patients with primary lung cancer underwent thoracotomy. Twelve (1.6%) had postoperative IP. Eight of the 12 died due to IP and 9 of the 12 had focal IP findings on chest computed tomography (CT). Chest CT of 477 patients were reviewed retrospectively, and 51 (10.7%) had IP findings (diffuse 2.1%, focal 8.6%). Postoperative IP occurred in 17.6% of patients with IP findings, but only in 0.7% without such findings (p<0.01). Values of serum KL-6 decreased after lung resection. There were no changes in the value of serum TNF-alpha, IL-1beta, thrombomodulin and sICAM-1 after surgery. We conclude that focal IP is a risk factor of postoperative IP, and that it is not useful to measure serum markers for early detection of postoperative IP.

A 79-year-old man was admitted for advanced transverse colon cancer with large bowel obstruction. Twelve years earlier he underwent a total gastrectomy with Roux-en Y reconstruction for gastric cancer. No metastasis was detected preoperatively. Exploratory laparotomy revealed massive direct invasion of the mesenterium of the jejunum for Roux-en Y reconstruction. The primary lesion was unresected and transverse colostomy was made. Systemic chemotherapy with 5-fluorouracil and l-leucovorin was scheduled for a total of 4 courses postoperatively. After completion of this chemotherapeutic regimen, a CT scan and colonofiberscopy revealed the primary lesions had disappeared, and a histological examination of biopsy confirmed that the patient had achieved a complete remission (CR). There was no severe side effect during chemotherapy. The patient is presently enjoying a good general condition and has been free from any sign of recurrence.

2,4-Dienoyl-CoA reductases from Escherichia coli and bovine liver were purified and characterized by the authors and almost simultaneously by Kunau and his colleagues around the early 1980s. The authors purified 2,4-dienoyl-CoA reductase from rat liver, cloned its cDNA and expressed its active form in Escherichia coli for the first time. Schulz and his colleagues have elaborately shown that mutant E. coli, in which the activity of the 2,4-dienoyl-CoA reductase is reduced to 12% of that in the parental strain, can grow on oleic acid but not on (Z)-6-octadecenoic acid as a sole carbon source. A single sporadic human fatality, in which the activities of 2,4-dienoyl-CoA reductases were reduced and accumulation of (2E,4Z) 2,4-decadienoylcarnitine was observed, has so far been reported. These taken together with the discovery of a novel delta3,5-delta2,4-dienoyl CoA isomerase and the absence of 3-hydroxyacyl-CoA epimerase have caused the classical metabolic pathway for beta-oxidation of unsaturated fatty acids, depicted by Stoffel in 1965, to be rewritten, and 2,4-dienoyl-CoA reductases are now known to be essential to beta-oxidation of unsaturated fatty acids. Very recently a single amino acid substitution adjacent to the NADPH binding site has been reported in pigs, suggesting that single nucleotide polymorphism will also be found to occur in humans.

Background: The transintervertebral disc approach was proposed recently for percutaneous neurolytic celiac plexus block (NCPB). Its superior simplicity, reliability, as well as safety potentially overcome the technical hurdles of NCPB that may interfere with the practical use of this validated analgesic intervention for abdominal cancer pain. The present study was conducted to evaluate the effectiveness of the use of this approach in a resident education program for NCPB., Methods: The clinical results of NCPBs conducted from January 2001 to September 2002 were examined comparing that performed by institutional residents with that by specialized physicians authorized by the Japanese Society of Pain Clinicians. The transintervertebral disc approach was used in all cases. Each resident completed NCPB under close supervision of the specialists., Results: Twenty-four patients received NCPB during the study period. Seven residents randomly completed 12 procedures and 4 specialists did others. The duration of fluoroscopy to complete the procedure was 256+/-109 sec in the resident group and 392+/-194 sec in the specialist group (ns). Significant pain reduction was obtained immediately after NCPB in all patients without any intergroup difference. No critical complication was observed in each group., Conclusions: The transintervertebral disc approach can be used effectively and safely in educational practice of NCPB for less-trained physicians.

A 8-year-old boy with acute lymphocytic leukemia (ALL) had received chemotherapy and a complete bone marrow remission was obtained. Then he underwent bone marrow transplantation. After 6 months, he suddenly got left flank-low abdominal pain. Sequentially, he had swelling and redness of left scrotum, left testicular swelling and tenderness. Incision was done and enlarged and hard testis was diagnosed as testicular tumor, left orchiectomy was performed. Histological diagnosis was involvement of ALL, so he received radiotherapy. He remains free of disease by the present after 7 months.

Prostate cancer is the most common urogenital cancer, and is increasing rapidly. We performed an epidemiological study on prostate cancer in Gunma Prefecture, Japan. Registration of prostate cancer patients diagnosed at clinics and hospitals in and around Gunma Prefecture was started at Gunma University in 1985. The epidemiological characteristics of prostate cancer patients in Gunma Prefecture were analyzed by these data. The incidence and crude incidence rates have increased five-fold, from 114 and 12.0 in 1985 to 539 and 53.9 in 2000, respectively. The age-adjusted incidence rate (adjusted to the world population) was increased three-fold, from 8.3 in 1985 to 24.2 in 2000. The age-specific incidence rate showed an increase with age. The cancers in clinical stages A and D decreased, while those in stages B and C increased. No change in distribution was observed in pathological differentiation. Prostate cancer has increased rapidly during these 16 years in Gunma Prefecture. It is important to perform PSA testing aggressively in males age 50 or older, and detect prostate cancer in an early stage.