Asia
1. Outline of the ProjectCountry:

Project title:

China

The Joint Study Project on Early Detection and Diagnosis of Prostatic Cancers in Jilin
Province

Issue/Sector:

Cooperation scheme:

Health/Medical Care

Research Cooperation

Division in charge:

Total cost:East,Central Asia,and the Caucasus
Division, Regional Department II

78 million yen

Period ofCooperation

1 Aug 1997 - 31 Partner Country's Implementing Organization:
July 2002
Jilin University, Jilin Provincial Commission of Science and Technology, The Center ofPreventive Research in Prostate Diseases of Jilin University(in the China-Japan Union
Hospital)

Supporting Organization in Japan:
Miyagi Prefecture,Miyagi Cancer Center

Related Cooperation:
Grant Aid ; "Project for the Improvement of the Equipment of Norman Bethure University of Medical Science"

1-1 Background of the Project
In China, cancer was ranked as one of the major diseases in terms of the number of patients who suffered from its ravages.
While the proportion of cancer patients was not significantly high, the number of cancer patients had steadily increasing. Having
become one of the major causes of death in the country, this treat to the health of the people in China could no longer beignored.
Since 1995, the Miyagi Cancer Center Division of Urology has conducted research that compares the medical examinations forprostate cancer of Japan and China, and participated in international joint research with the Norman Bethune University ofMedical Science, which through integration has become the Jilin University and Hospital of the First Automobile Works. Throughthese international exchanges, the Jilin Provincial Commission and the Government of China realized that cancer would
continue to be a serious disease in China and, as a result, requested the Government of Japan to provide technical cooperation
to develop human resources and conduct a joint study in order to establish systems for early detection and diagnosis of prostatecancer.

1-2 Project Overview
As the Center of Preventive Research into Prostate Diseases of Jilin University and with Jilin Provincial Commission of Scienceand Technology serving as the implementing organization, the Project implemented the research cooperation (urology,pathology, biochemistry and epidemiology) on the detection and diagnosis of prostate cancer and established a system ofdiagnosis. The project trained the Center's staff through research activities, classes and seminars.
(1) Overall Goal
The health screening system on prostate cancers will be integrated in the Jilin Province.

(2) Project Purpose
The systematic structure to implement the health screening system on prostate cancers will be organized in the target area.
(3) Outputs
1) A management structure of the health screening system on prostate cancers is developed.
2) The technical capability of the counterparts is upgraded.
3) The implementation structure of the health screening system on prostate cancers is established.
4) The outcome of the Joint Study is published(4) Inputs
Japanese side:
Long-term Expert

1

Equipment and Facilities

Short-term Experts

25

Local cost 684,973 Yuan (11 Million Yen)

Trainees received

1176 Million Yen

Chinese side:Counterparts

38Local Cost

3.175 Million Yuan (51 Million Yen)

2. Evaluation Team
Members of Evaluation Team

Team Leader/General: Tasuke KONNO, Presodent, Miyagi Cancer Center
Technical Transfer Planning: Keizo KAGAWA, Deputy Director, Tohoku Branch Office,JICA
Evaluation Management: Mitsuaki INOUE, East, Central Asia, and the Caucasus
Division, Regional Department 2, JICA
Evaluation Analysis: Ryosuke SASAKI, Tohmatsu & Co.
Interpretation: Yoko KATO, Japan International Cooperation Center

Period of Evaluation

20 January 2002 - 2 February 2002

Type of Evaluation:
Terminal Evaluation

3. Results of Evaluation
3-1 Summary of Evaluation Results(1) RelevancePatients with prostate cancer have presented without subjective symptoms, and diagnosis of prostate cancer was largely
dependent on conventional technologies such as echo-cardiography and rectal palpation by which only the terminal symptoms
of prostate cancer could be detected. Early detection and diagnosis of prostate cancers would become possible by ultrasonicdiagnostic examination; however, in Julin Province a prostate cancer examination system had not yet been established. TheProject was the first trial to introduce the prostate cancer examination system. The Project Purpose, "a systematic structure toimplement a health screening system for prostate cancer will be established in the target area" which at that time had notechnical capacity in the field of medicine at that time," was appropriately set in order to achieve the Overall Goal. As Julin
University regarded the above mentioned research as one of the five major fields of the international cooperation, the Project
was in line with the University Policy.
(2) Effectiveness
The Project Purpose is likely to be achieved by the time of Project completion. The counterparts have obtained basic techniques

to conduct the health screening on prostate cancers through seminars and trainings. The counterparts have been conducting
health screening for prostate cancer in Chang Chun City, where the number of beneficiaries screened numbered over 12,000 at
the termination of the Project. Among them, test results were positive for 813; and 273 of the test subject took a second healthscreening test for prostate cancer and 69 were diagnosed as having prostate cancer. The health screening tests largely
contributed to the early detection and diagnosis of cancer (as of May 2003). Six research papers have been gained academic
recognition, and the Ministry of Science and Technology, Jilin Provincial Commission of Science and Technology and Julin
University funded the research. As the Project has introduced health screening in the target area for the first time, achievementof the Project Purpose was significantly attributed to Project Outputs.
(3) Efficiency
The quantity, quality and timing of the Inputs were appropriate for the most part, and the Inputs were efficiently turned into theOutputs. In particular, as the experts in the Project were mainly Short-term Expert, the short-term experts were dispatched rightafter the participants in training in Japan returned to China where they efficiently trained the counterparts. One of the external
factors that influenced the efficiency of the Project was the merger of the Norman Bethune University of Medical Sciences, theoriginal implementing organization, and Julin University in June 2000. The merger positively affected the efficiency of the Projectby strengthening human resources and facilitating allocation of a local budget from the university, although administrative
procedures were temporarily delayed during the transition period. Overall, the Project has been efficiently implemented becauseof the cooperation between Jilin Province and Miyagi Prefecture prior to Project Implementation.
(4) Impact
The Project's introduction of new medical practices to detect prostate cancer the early stages had an innovative impact on thehealth sector in the target area . As conventional diagnostic methods only detected the terminal symptoms of prostate cancer,
the Project increased the possibility of successful treatment of prostate cancers. However, it will take a few more years toachieve the Overall Goal. Some issues concerning Project outcomes still remain. These include pending comprehensive
dissemination of outcomes throughout Jilin Province, which consists of mainly rural areas, and the fact that health screening isneither broadly recognized nor understood.
(5) Sustainability
It is clear by the indicators of the conducted health screening for prostate cancer in Chang Chun City that the counterparts had
sustainable capabilities in medical and analytical techniques and that the data obtained through health screening was wellmanaged. The Center of Preventive Research in Prostate Diseases of Jilin University has already settled the mid-term
objectives for the next five years to enhance health screening and has clear aims with regard to sustainability. Moreover, Julin
University places a high priority on the research conducted by the counterparts and grants to assist the joint study have been
continuously provided along with an adequate budget.
With regard to finances, the Center of Preventive Research in Prostate Diseases will be transferred to the China-Japan Union
Hospital in June 2002, and health insurance will be applied to treatments. Therefore, the cost of health screening can beappropriated to research, and further collaboration between the basic medical sciences and clinical medicine is also expected.
Thus, the impacts produced by the Project will be sustainable even after completion of the Project.

3-2 Factors that promoted realization of effects(1) Factors concerning Planning
N/A.
(2) Factors concerning the Implementation Process
More Long-term Experts and Short-term Experts were dispatched than originally planned. With the help of the Long-termExperts, Project management was smoothly conducted. As the Short-term Experts were incumbent doctors, a longer stay wasdifficult. This was offset by the dispatch of additional Short-term Experts. This flexible approach helped to accomplish ProjectOutputs.

3-3 Factors that impeded realization of effects(1) Factors concerning Planning
N/A(2) Factors concerning the Implementation Process
N/A

3-4 Conclusion
The Project accomplishes the Project Purpose and Outputs as originally planned, such as the establishment of a sequence ofsystems for the collaboration research and experiments, establishment of a health screening system, improvement of a future
health screening system for prostate cancer in Jilin Province and upgrading research capabilities both in China and Japan.

3-5 Recommendations(1) As the Center of Preventive Research in Prostate Diseases will be transferred to the China-Japan Union Hospital, one
urology physician and one pathologic test technician of took the three-month training course at the Miyagi Cancer Center (as ofMay 2003) for safe and efficient health screening (biochemistry screening on prostate) into the future.
(2) The health screening is the collaborative basic-research activity among clinicians, pathologists, biochemists, andepidemiologists who evaluate the effects of screening effects and upgrade efficiency. Therefore, it is necessary to promotetechnical improvement in each field and continuous exchange of information among specialists. The Project should be followed
up and experts dispatched on an ongoing basis in the technically immature fields for a few years.
(3) The research results at the Center are expected to contribute to the prevention and treatment of cancer both in Japan andChina as the information is essential for the prostate cancer research in Japan, as well. Therefore, the Japanese side should
continue to help promote the dissemination of the health screening system, the ongoing exchange of information, provide
instructions in the specialized fields and try to share the research achievements.

3-6 Lessons Learned(1) There was some concern that it was too early to introduce the health screening system on prostate cancer requested byGovernment of China. However, as a result the system's introduction, the pioneers of the Project were a focus of attention
nationwide. The Project was recognized as the main international exchange program of Jilin University, and the futuresustainable development is greatly expected. In the selection of future projects of this nature, this Project serves as a goodreferential example.
(2) The Project emerged as a result of the long and friendly ties between Miyagi Prefecture and Jilin Province, and the roles of
the implementing organization and the Project Purpose were clear from the planning stage. In case of Local Governmental Units
implementation of the collaborative work, it is important to formulate the Project considering the international exchange history of
the Local Governmental Units.
(3) In general, in implementing a project, it takes time for the Project activities to get fully underway because of the time needed
for preparation. However, in the case of this Project, project leaders in Japan and China already had a teacher and student
relationship at Tohoku University, which contributed to smooth communications and a short preparation time. The mutual trust
owing to the long-time friendship program contributed to the quick implementation of the Project.
(4) The Project coordinator, who had experienced many projects in China and understood the situation at China, contributed tothe smooth management of the Project.

3-7 Follow-up Situation
The dispatch of Short-term Experts in Grassroots Technical Cooperation (local proposal type) and acceptance of trainees havebeen considered from FY2003 in the field of clinical and epidemiology studies on early detection and diagnosis of prostatecancer.