[A survey on the utilization of internet services to collect job information among medical students and initiation of video public relations activities for the recruitment of public health physicians based on the survey results].

Objectives　It is difficult for medical students to obtain information about public health physicians because there are very few public health physicians near them. To improve this situation, we surveyed the utilization of internet services to collect job information among medical students and produced six videos and conducted public relations activities for the recruitment of public health physicians based on the survey results.Methods　The subjects of the survey were medical students in their third year or above from 18 universities. Public health teachers in these 18 universities sent their students anonymous self-administered questionnaires created with Google Forms mainly by e-mail. The questionnaires included the following items "internet services used to collect job information," "desired length of each video for knowing job information," and "information you want to know about your future work." The responses were reflected in the length and the content of the videos and the settings for their distribution.Results　Responses were obtained from a total of 491 medical students, including 14 third-year students, 177 fifth-year students, and 300 sixth-year students. Homepages were the most frequently used online source for collecting job information (94.7%), followed by blogs (42.0%), Twitter (32.6%), and YouTube (18.9%). Medical students are less likely to use social networking services for collecting job information compared with non-medical job-hunting students. Regarding the length of the videos, 55.8% of the respondents preferred the length of one video to be less than 5 minutes, and 95.1% preferred it to be less than 10 minutes. Almost all of the respondents (93.1%) wanted to know the atmosphere of young public health physicians, and 74.1% also wanted to know the atmosphere of veteran physicians. Based on these results, we selected six public health physicians including young and veteran physicians and produced interview videos that conveyed the atmosphere of each doctor within 5 minutes per person. We refurbished the banner on the top page of the Japanese Association of Public Health Center Directors so that the videos uploaded to YouTube could be watched.Conclusion　We clarified the current situation of the utilization of internet services for job-hunting activities among medical students and were able to initiate video public relations activities for the recruitment of public health physicians in accordance with the needs. It is necessary to increase awareness of the video platform among medical students and clinicians by deepening cooperation with local governments, universities, and medical institutions and expanding the human network both online and in person.

Psychological distress in men with prostate cancer and their partners before and after cancer diagnosis: a longitudinal study.

OBJECTIVE: To examine the relative risk of psychological distress of men with prostate cancer and their partners during the period before and after prostate cancer diagnosis compared with men without prostate cancer and their partners. METHODS: The participants reported questionnaires on psychological distress at four time points: before prostate cancer biopsy, and at 1, 3 and 6 months following prostate cancer diagnosis. We performed multiple logistic regression analyses to examine the relative risk of psychological distress. RESULTS: A total of 115 couples answered the questionnaires at all four time points. Men with prostate cancer showed a significantly higher risk of psychological distress compared to men without prostate cancer at 1 (odds ratio [OR] = 4.8, 95% confidence interval [CI] = 1.9-13.1), 3 (OR = 3.2, 95% CI = 1.1-10.2) and 6 months following prostate cancer diagnosis (OR = 6.9, 95% CI = 2.3-25.7). Their partners showed a significantly higher risk of psychological distress compared to the partners of men without prostate cancer at 1 month following prostate cancer diagnosis (OR = 2.6, 95% CI = 1.1-6.6). CONCLUSIONS: Men with prostate cancer showed psychological distress during the 6 months following the cancer diagnosis. Their partners also showed psychological distress at 1 month following the cancer diagnosis. Inviting both men with prostate cancer and their partners to speak to their concerns, empathizing with them, finding the solutions together and monitoring of their psychological status regularly should be regarded as important following prostate cancer diagnosis.

Psychosocial longitudinal study profile and distress of couples in relation to the conduct of prostate biopsy.

OBJECTIVE: Partners of prostate cancer patients have been reported to suffer from high levels of psychological distress, although there are few reports of the changes in their distress levels observed before and after the diagnosis and the factors influencing them. This study constructed a longitudinal psychosocial database of prostate cancer biopsy subjects and their partners. This paper describes a summary of the database and the nature and severity of the psychological distress and cancer-related worry. METHODS: We distributed self-administered questionnaires to subjects scheduled for a prostate cancer biopsy and their partners on four occasions: prior to the biopsy, and 1, 3 and 6 months after being informed whether the diagnosis was cancer or not. The questionnaires included questions pertaining to the psychological distress, cancer-related worry and correlational factors. RESULTS: Of the 240 couples who agreed to participate in the database project, 184 couples completed the first and second surveys; thus, the database consists of them. While no significant differences in the levels of psychological distress were found among the participants before the biopsy, the prostate cancer patients and their partners had significantly higher levels of psychological distress as compared with the non-prostate cancer patients at 1 month after being informed whether the diagnosis was cancer or not. CONCLUSIONS: This study constructed a longitudinal psychosocial database of prostate cancer biopsy subjects and their partners. Our findings suggest that partners of prostate cancer patients might experience a similar psychological impact to the prostate cancer patients before and after the diagnosis.

Radar-enabled recovery of the Sutter's Mill meteorite, a carbonaceous chondrite regolith breccia.

Doppler weather radar imaging enabled the rapid recovery of the Sutter's Mill meteorite after a rare 4-kiloton of TNT-equivalent asteroid impact over the foothills of the Sierra Nevada in northern California. The recovered meteorites survived a record high-speed entry of 28.6 kilometers per second from an orbit close to that of Jupiter-family comets (Tisserand's parameter = 2.8 ± 0.3). Sutter's Mill is a regolith breccia composed of CM (Mighei)-type carbonaceous chondrite and highly reduced xenolithic materials. It exhibits considerable diversity of mineralogy, petrography, and isotope and organic chemistry, resulting from a complex formation history of the parent body surface. That diversity is quickly masked by alteration once in the terrestrial environment but will need to be considered when samples returned by missions to C-class asteroids are interpreted.

Proprostate-specific antigen: its usefulness in the era of multiple-core prostate biopsy.

OBJECTIVE: To investigate the clinical significance of prostate-specific antigen (PSA)-related markers, including the precursor form of PSA, using the full-range area under the curve of receiver operating characteristics (AUC-ROC), partial AUC-ROC (pAUC-ROC) and multiple logistic regression analyses. METHODS: Participants consisted of 257 consecutive men (PSA range 4.1-20 ng/mL) undergoing transrectal ultrasonography-guided age-adjusted and prostate volume-adjusted multiple-core prostate biopsy at Gunma University Hospital between January 2003 and May 2005. Sensitivity, specificity, AUC-ROC and pAUC-ROC of the ratio of free PSA to total PSA (free/total PSA), PSA density (PSAD) and PSAD adjusted by transition zone volume, the ratio of [-7/-5] precursor forms of PSA (proPSA) to free PSA (pro/free PSA), the ratio of pro to total PSA and the ratio of pro to free/total PSA (pro/f/t ratio) were investigated. Multiple logistic regression analyses were also carried out to investigate the independency of selected clinical parameters. RESULTS: According to pAUC-ROC analyses, pro/free PSA and the pro/f/t ratio were the two best PSA-related parameters in terms of maintaining high sensitivity and avoiding unnecessary biopsy. Multiple regression analyses revealed that not only pro/free PSA, but also age, findings on digital rectal examination and PSAD were independent parameters for predicting biopsy outcomes. CONCLUSION: Pro/free PSA and pro/f/t ratio may be excellent predictive markers for prostate cancer, allowing unnecessary biopsy to be avoided while maintaining high sensitivity at 90% or 95%, in the PSA range 4-20 ng/mL.

Changes in baseline PSA levels in Japanese men from 1988 to 2003.

OBJECTIVES: According to epidemiologic surveys, the number of deaths from prostate cancer in Japanese men increased rapidly from 1970 to 2006. However, it is difficult to know the real incidence of, and mortality due to, prostate cancer because the reliability of death certificates and the cancer registry system in Japan are poor. Recently, several studies have demonstrated that baseline prostate-specific antigen (PSA) levels could be one of the most important predictive factors for developing prostate cancer. Therefore, we hypothesized that changes in the baseline PSA distribution in the screening population could reflect trends in the true incidence rate of prostate cancer. METHODS: From 1988 to 2003, 32,274 men, aged 50-79 years, participated in population-based screening for prostate cancer for the first time in Gunma Prefecture, Japan. Changes in the baseline PSA distributions, stratified by a 5-year age range and calendar year, were investigated. The relationships between age and log(10) PSA levels were also investigated and stratified by calendar year. RESULTS: The median baseline PSA level was 0.9-1.2 ng/mL and had not recently increased. No specific trends were found in the percentages of participants with a PSA level greater than 2.0, 4.0, or 10.0 ng/mL within the same age range during the 16-year period. CONCLUSIONS: The increase in the incidence of, and mortality rates for, prostate cancer demonstrated by epidemiologic research might have been misleading in Japan. Investigational changes in the baseline prostate-specific antigen (PSA) distribution of the screened populations revealed that the true incidence rate of prostate cancer in Japan might have been almost the same during the past 16 years.

Prostate-specific antigen kinetics in screen-detected prostate cancer in Japan.

OBJECTIVES: It would be of value to compare the features of prostate cancer detected in various screening series around the world. Recently, some studies have demonstrated the value of pretreatment prostate-specific antigen (PSA) kinetics in predicting the outcome of radical prostatectomy and radiotherapy for men with localized prostate cancer. Therefore, the distribution of PSA velocity (PSAV) or PSA doubling time in screen-detected prostate cancer might be objective parameters to investigate how well each national screening system is working. METHODS: From 1992 to 2004, 957 men with prostate cancer were detected by screening in Gunma Prefecture, Japan. Of those, 275 men (29%) detected with consecutive screening tests participated in the present study. The PSAV was calculated by the PSA change between the most recent screening test and cancer diagnosis and also by linear regression analysis. The PSA doubling time was also calculated for 146 men who underwent screening at least three times. RESULTS: The median PSAV was 1.3 ng/mL/yr in those with Stage T1cN0M, 1.1 ng/mL/yr in those with T2N0M0, and 2.1 ng/mL/yr in those with T3N0M0. The percentage of men with a PSAV (linear regression analysis) greater than 2.0 ng/mL/yr was 13%, 12%, and 49% in men with clinical Stage T1cN0M0, T2N0M0, and T3N0M0, respectively. The median PSA doubling time was 57.1, 51.7, and 28.0 months for those with T1cN0M0, T2N0M0, and T3N0M0, respectively. CONCLUSIONS: Patients with prostate cancer with aggressive features are still detected in the population-based screening system in Japan. Even in Japan, where PSA screening is perhaps the most widespread among Asian countries, the screening system might be still immature compared with the systems in the United States and Western Europe.

Nomogram ranking as new objective evaluation method in various treatment strategies for patients with prostate cancer with various clinicopathologic backgrounds.

OBJECTIVES: To propose a "nomogram ranking" that gives an objective assessment of any treatment strategy from various institutions. It is difficult to objectively compare treatment outcomes for patients with prostate cancer among institutions because of the large differences in the clinicopathologic backgrounds and treatment strategies. METHODS: From January 2001 to September 2005, 71 consecutive patients with locally advanced prostate cancer were treated with external beam radiotherapy (EBRT) and subsequent high-dose rate brachytherapy combined with long-term hormonal therapy. The 5-year prostate-specific antigen relapse-free survival (PFS) rates were calculated by Kaplan-Meier analysis for all patients and also for subdivided patients according to prostate-specific antigen range or Gleason score. Also, the 5-year PFS rates were estimated by Kattan nomogram, assuming that all 71 patients were treated with 72 Gy of EBRT or EBRT plus neoadjuvant hormonal therapy. The estimated PFS rates were ranked in order from worse to better outcomes (nomogram ranking). The 5-year PFS rates estimated by Kaplan-Meier analysis assessed the position within the nomogram ranking. RESULTS: The 5-year PFS rate estimated by Kaplan-Meier analysis for all 71 patients was 82.4%. The median 5-year PFS rate estimated by Kattan nomogram was 66%, assuming that all patients were treated with EBRT and neoadjuvant hormonal therapy. The actual 5-year PFS rate estimated by Kaplan-Meier analysis ranked 56 of 71 patients assumed to be treated with neoadjuvant hormonal therapy and EBRT. Subdivided analyses revealed that our treatment strategy might be advantageous for patients with a Gleason score of 7 or less, regardless of the prostate-specific antigen level. CONCLUSIONS: The nomogram ranking might be an objective and reliable assessment method of various treatment strategies for patients with prostate cancer.

Lead time of prostate cancer detected in population based screening for prostate cancer in Japan.

PURPOSE: We clarified that lead time bias in screen detected prostate cancer is important for evaluating the outcome of any individual screening system. MATERIALS AND METHODS: Between 1992 and 2001, 195 and 958 prostate cancer cases with clinical T1c/T2N0M0 and T3N0M0 disease were enrolled in the current study as screen detected and outpatient clinic detected prostate cancer, respectively. Log10 prostate specific antigen velocity was calculated using log10 prostate specific antigen at diagnosis and at the most recent screening before cancer detection. Lead time in screen detected cancer was then estimated as the year when log10 prostate specific antigen in screen detected cancer would increase to the levels of log10 prostate specific antigen in outpatient clinic detected prostate cancer. RESULTS: Median log10 prostate specific antigen was 0.87 and 1.08 ng/ml for clinical T1c/T2N0M0 disease, and 1.14 and 1.53 ng/ml for T3N0M0 disease in screen and outpatient clinic detected cancer, respectively. The 25th, 50th and 75th percentiles of log10 prostate specific antigen velocity before cancer detection in the screening population were 0.05, 0.08 and 0.14 for T1c/T2N0M0 disease, and 0.07, 0.13 and 0.21 for T3N0M0 disease, respectively. The 25th, 50th and 75th percentiles of expected lead time in screen detected cancer were 1.9, 3.3 and 5.2 years for T1c/T2N0M0 disease and 1.4, 2.2 and 4.1 years for T3N0M0 disease, respectively. CONCLUSIONS: The lead time of screen detected cancer in our screening system is not as long as previously thought. This new methodology for lead time estimation may be useful for evaluating treatment outcomes of screen detected prostate cancer in individual screening systems done in various regions worldwide.

Cumulative probability of PSA increase above 4.0 NG/ML in population-based screening for prostate cancer.

Routine screening for prostate cancer remains controversial. However, it is very important to show how the optimal rescreening interval should be set for men who want to be screened after informed consent. To solve this issue, the risk of prostate-specific antigen (PSA) increase above 4.0 ng/ml relative to baseline PSA levels and age was investigated. Between 1988 and 2000, 7,757 subjects screened twice or more and also with baseline PSA levels of 4.0 ng/ml or lower were enrolled in our study. All serum PSA levels were measured by E-test Tosoh II PA assay at one center. Interval PSA levels for men undergoing screening with a greater than 1 year interval were calculated on the assumption that PSA levels changed over time in a simple exponential fashion. Then, the cumulative rate of freedom from PSA increase above 4.0 ng/ml was estimated using the Kaplan-Meier technique stratified by baseline PSA ranges of 0.0 to 1.0, 1.1 to 2.0, 2.1 to 3.0 and 3.1 to 4.0 ng/ml and every 10 years of age ranges. Of the 7,757 subjects, 559 (7.2%) were expected to have had PSA levels increase above 4.0 ng/ml within 5 years after the baseline PSA measurements. The cumulative rate of freedom from the PSA increase above 4.0 ng/ml at 5 years was 98.7%, 92.9%, 70.3% and 38.5% in cases of baseline PSA levels of 1.0 ng/ml or lower, 1.1 to 2.0 ng/ml, 2.1 to 3.0 ng/ml and 3.1 to 4.0 ng/ml, respectively. The cumulative rates of freedom from the PSA increase were significantly decreased with the baseline PSA ranges being higher regardless of age range. Re-screening interval should be set stratified by baseline PSA levels, regardless of age and race. Rescreening interval should be set at 1, 1 to 2 and 3 to 5 years for men with baseline PSA ranges of 2.1 to 4.0 ng/ml, 1.1 to 2.0 ng/ml and 0.0 to 1.0 ng/ml, respectively, in individual-based screening. In mass screening system using PSA alone, rescreening interval should be set in the same manner as in individual-based screening, except for men with baseline PSA levels of 1.1 to 2.0 ng/ml, which should be set at 1 year to avoid developing incurable prostate cancer.

Comparative study on the prevalence of clinically detectable prostate cancer in patients with and without bladder cancer.

OBJECTIVES: To investigate the prevalence of prostate cancer in patients with a past or present history of bladder cancer compared with age-matched control subjects in population-based screening for prostate cancer. METHODS: Between 1998 and 2000, 106 patients who were followed up in the outpatient clinic for bladder cancer (case cohort) and 1060 age-matched men who participated in screening for prostate cancer (control cohort) were enrolled in this study. Serum prostate-specific antigen (PSA) levels were measured for all participants, and all participants underwent digital rectal examination (DRE). The PSA distribution and prevalence rate of prostate cancer were compared between these two cohorts. RESULTS: The serum PSA levels were significantly greater in the case cohort than in the control cohort. The detection rate of prostate cancer was 12.3% (13 of 106) and 1.5% (16 of 1060) in the case and control cohorts, respectively. The biopsy compliance for those with abnormal PSA and/or DRE findings was significantly lower (31%) in the control cohort than in the case cohort (84%). If all those in the control cohort with abnormal PSA and/or DRE findings had undergone prostate biopsies, another 26 cases of prostate cancer might have been detected. The expected detection rate of prostate cancer in the control cohort was high at 4.0% (42 of 1060); however, this was still significantly lower than that in the case cohort. CONCLUSIONS: Patients with a present or past history of bladder cancer could be a high-risk group for developing or having prostate cancer. Additional studies should be conducted to confirm this.

Natural history of PSA increase with and without prostate cancer.

OBJECTIVES: To investigate the natural history of prostate-specific antigen (PSA) increase in men with and without prostate cancer to clarify the probability of cancer-related PSA increase. METHODS: Between 1986 and 2001, 504 men aged 79 years or younger with baseline PSA levels of 4.0 ng/mL or less and a PSA increase greater than 4.0 ng/mL on consecutive screening were enrolled in this study. The types of PSA increase were classified as "non-cancer-related PSA increase," "suspicious cancer-related PSA increase," and "cancer-related PSA increase." The probability of a "cancer-related PSA increase" was investigated and stratified by baseline PSA levels and elapsed years until the PSA level increased to greater than 4.0 ng/mL. RESULTS: The probability of a "non-cancer-related increase," "suspicious cancer-related PSA increase," and "cancer-related PSA increase" was 57%, 15%, and 28%, respectively. The PSA velocity before the PSA increase was not significantly different between those with and without prostate cancer. A "non-cancer-related PSA increase" was observed in 92% of those with a PSA increase within 2 years of baseline PSA ranges of 2.0 ng/mL or less. Regardless of elapsed years until a PSA increase to greater than 4.0 ng/mL, a "suspicious cancer-related PSA increase" or "cancer-related PSA increase" was observed in almost one half of those with baseline PSA levels of 2.1 to 4.0 ng/mL. CONCLUSIONS: Intensive serial observations should be recommended before undergoing biopsy for those with a PSA increase within 2 years of a baseline PSA range of 0.0 to 2.0 ng/mL. It may be difficult to distinguish between those with and without cancer using only subsequent total PSA measurements for the remaining cases, and prostate biopsy should be recommended at present.

Possibility of re-screening intervals of more than one year in men with PSA levels of 4.0 ng/ml or less.

BACKGROUND: The optimal re-screening interval is one of the most important issues to evaluate the effectiveness of screening for prostate cancer. METHODS: Between 1992 and 2000, 7,026 men aged 50-78 with baseline PSA levels of 4.0 ng/ml or lower underwent screening for prostate cancer twice or more. The risk of developing prostate cancer relative to elapsed years and baseline PSA levels were investigated. RESULTS: Prostate cancer was detected in a total of 127 cases (1.8%). The detection rate of prostate cancer was high between 1.6% and 5.5% at 1 year after baseline PSA measurements in men with baseline PSA levels of 2.1-4.0 ng/ml. In men with baseline PSA levels of 1.1- 2.0 ng/ml, the detection rate increased from 0.06% to 1.02% with passed years. The proportion of stage >/=T3 was high at 63% in prostate cancer cases detected between 3 and 4 years after baseline PSA levels being 1.1-2.0 ng/ml. In men with baseline PSA levels of 1.0 or lower, the cumulative detection rate of prostate cancer was low at 0.01% within 3 years, however, the detection rate increased to 0.34% after 5 or more years from baseline PSA measurements. CONCLUSIONS: The re-screening interval was recommended to be 1, 1-2, and 3-5 years for men with baseline PSA levels of 2.1-4.0 ng/ml, 1.1-2.0 ng/ml, and 1.0 ng/ml or lower, respectively.