***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND And rogen-deprivation therapy is offered to men with prostate cancer who have a rising prostate-specific antigen after curative therapy ( PSA relapse ) or who are considered not suitable for curative treatment ; however , the optimal timing for its introduction is uncertain . We aim ed to assess whether immediate and rogen-deprivation therapy improves overall survival compared with delayed therapy . METHODS In this r and omised , multicentre , phase 3 , non-blinded trial , we recruited men through 29 oncology centres in Australia , New Zeal and , and Canada . Men with prostate cancer were eligible if they had a PSA relapse after previous attempted curative therapy ( radiotherapy or surgery , with or without postoperative radiotherapy ) or if they were not considered suitable for curative treatment ( because of age , comorbidity , or locally advanced disease ) . We used a data base-embedded , dynamically balanced , r and omisation algorithm , coordinated by the Cancer Council Victoria , to r and omly assign participants ( 1:1 ) to immediate and rogen-deprivation therapy ( immediate therapy arm ) or to delayed and rogen-deprivation therapy ( delayed therapy arm ) with a recommended interval of at least 2 years unless clinical ly contraindicated . R and omisation for participants with PSA relapse was stratified by type of previous therapy , relapse-free interval , and PSA doubling time ; r and omisation for those with non-curative disease was stratified by metastatic status ; and r and omisation in both groups was stratified by planned treatment schedule ( continuous or intermittent ) and treatment centre . Clinicians could prescribe any form and schedule of and rogen-deprivation therapy and group assignment was not masked . The primary outcome was overall survival in the intention-to-treat population . The trial closed to accrual in 2012 after review by the independent data monitoring committee , but data collection continued for 18 months until Feb 26 , 2014 . It is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12606000301561 ) and Clinical Trials.gov ( NCT00110162 ) . FINDINGS Between Sept 3 , 2004 , and July 13 , 2012 , we recruited 293 men ( 261 with PSA relapse and 32 with non-curable disease ) . We r and omly assigned 142 men to the immediate therapy arm and 151 to the delayed therapy arm . Median follow-up was 5 years ( IQR 3·3 - 6·2 ) from the date of r and omisation . 16 ( 11 % ) men died in the immediate therapy arm and 30 ( 20 % ) died in the delayed therapy arm . 5-year overall survival was 86·4 % ( 95 % CI 78·5 - 91·5 ) in the delayed therapy arm versus 91·2 % ( 84·2 - 95·2 ) in the immediate therapy arm ( log-rank p=0·047 ) . After Cox regression , the unadjusted HR for overall survival for immediate versus delayed arm assignment was 0·55 ( 95 % CI 0·30 - 1·00 ; p=0·050 ) . 23 patients had grade 3 treatment-related adverse events . 105 ( 36 % ) men had adverse events  requiring hospital admission ; none of these events were attributable to treatment or differed between treatment-timing groups . The most common serious adverse events were cardiovascular , which occurred in nine ( 6 % ) patients in the delayed therapy arm and 13 ( 9 % ) in the immediate therapy arm . INTERPRETATION Immediate receipt of and rogen-deprivation therapy significantly improved overall survival compared with delayed intervention in men with PSA-relapsed or non-curable prostate cancer . The results provide benchmark evidence of survival rates and morbidity to discuss with men when considering their treatment options . FUNDING Australian National Health and Medical Research Council and Cancer Councils , The Royal Australian and New Zeal and College of Radiologists , Mayne Pharma Australia BACKGROUND AND PURPOSE The ongoing Early Prostate Cancer ( EPC ) programme is assessing bicalutamide ( ' Casodex ' ) 150 mg , either alone or as adjuvant to treatment of curative intent , in patients with localised or locally advanced prostate cancer ( n=8113 ) . This paper presents an exploratory analysis of the subgroup of the EPC programme who received radiotherapy with curative intent ( n=1370 ) in order to determine the efficacy ( in terms of progression-free survival [ PFS ] ) and tolerability of bicalutamide 150 mg in this setting . PATIENTS AND METHODS 1370 patients with T1 - 4 , MO , any N prostate cancer received bicalutamide 150 mg or placebo adjuvant to radiotherapy of curative intent . This analysis was undertaken at median 5.3 years ' follow-up . RESULTS In patients with locally advanced disease ( n=305 ) , bicalutamide adjuvant to radiotherapy significantly increased PFS by 53 % ( event-time ratio 1.53 ; 95 % confidence intervals [ CI ] 1.16 , 2.02 ) compared with placebo and reduced the risk of disease progression by 42 % ( hazard ration [ HR ] 0.58 ; 95 % CI 0.41 , 0.84 ; P=0.00348 ) . In these patients , objective progression was experienced by 33.5 % of those r and omised to bicalutamide versus 48.6 % for those r and omised to placebo . The between-group difference in patients with localised disease ( n=1065 ) failed to reach statistical significance ( HR 0.80 ; 95 % CI 0.62 , 1.03 ; P=0.088 ) . The most common adverse events were breast pain ( 74.8 % ) and gynaecomastia ( 66.6 % ) , which were mild to moderate in > 90 % of cases . CONCLUSIONS Bicalutamide 150 mg/day given as adjuvant to radiotherapy significantly improved PFS in patients with locally advanced prostate cancer . For patients with localised disease , the results at this stage from the radiotherapy subgroup and the overall EPC programme suggest that adjuvant hormonal therapy is currently not appropriate . There were no unexpected tolerability findings PURPOSE To determine the potential advantage of and rogen ablation following st and ard external-beam radiation therapy in patients with locally advanced ( clinical or pathologic T3 ; clinical or pathologic node positive ) carcinoma of the prostate . METHODS AND MATERIAL S In 1987 the RTOG initiated a Phase III trial of long-term adjuvant goserelin in definitively irradiated patients with carcinoma of the prostate . A total of 977 patients were accrued to the study of which 945 remain analyzable : 477 on the adjuvant hormone arm ( Arm I ) ; and 468 on the radiation only arm ( Arm II ) with hormones  initiated at relapse . The initial results were reported in the Journal of Clinical Oncology in 1997 . RESULTS With a median follow up of 5.6 years for all patients and 6.0 years for living patients local failure at 8 years was 23 % for Arm I and 37 % for Arm II ( p < 0.0001 ) . Distant metastasis was likewise favorably impacted with the immediate use of hormonal manipulation with a distant metastasis rate in Arm I of 27 % and 37 % in Arm II ( p < 0.0001 ) . Disease-free survival ( NED survival ) and NED survival with PSA of 1.5 ng/mL ( bNED ) or less were both statistically significant in favor of the immediate hormone arm ( both p < 0.0001 ) . Cause-specific failure was not statistically different with a cause-specific failure of 16 % for Arm I and 21 % in Arm II ( p = 0.23 ) . Overall survival was likewise not statistically different between two arms , with a 49 % overall survival at 8 years in Arm I and 47 % in Arm II ( p = 0.36 ) . Subset analysis of central ly review ed Gleason 8 - 10 patients who did not undergo prostatectomy showed that for patients receiving radiation therapy plus adjuvant hormones there was a statistically significant improvement in both absolute ( p = 0.036 ) and cause-specific survival ( p = 0.019 ) . CONCLUSIONS Use of long-term adjuvant and rogen deprivation in addition to definitive radiation therapy results in a highly significant improvement in regards to local control , freedom from distant metastasis , and biochemical free survival in unfavorable prognosis patients with carcinoma of the prostate PURPOSE We evaluated changes in bone mineral density ( BMD ) , fat-free mass ( FFM ) and serum lipid levels during bicalutamide 150 mg monotherapy compared with medical castration for 2 years . MATERIAL S AND METHODS A total of 103 men with localized or locally advanced prostate cancer ( T1-T4 , Nx , M0 ) for whom immediate and rogen deprivation was indicated were enrolled in this prospect i ve , multicenter , open-label , parallel group study . Patients were r and omized to bicalutamide 150 mg once daily ( 51 ) or medical castration with a luteinizing hormone releasing hormone analogue ( 52 ) for 96 weeks . Primary end points were mean percent change from baseline in lumbar spine BMD , hip BMD and FFM at 96 weeks . Mean changes in lipid parameters with time were also evaluated . RESULTS BMD was maintained during bicalutamide 150 mg monotherapy ( + 2.42 % for lumbar spine BMD and + 1.13 % for hip BMD at week 96 ) , while castration was associated with a progressive loss in BMD ( -5.40 % and -4.39 % at week 96 , respectively , both p < 0.0001 at week 96 ) . There was no significant difference between bicalutamide 150 mg and castration in mean percent change from baseline in FFM ( -1.56 % and -3.86 % , respectively , at week 96 , p = 0.31 ) , although there was a trend for greater progressive loss over time with castration . Mean changes in lipid parameters were small and similar in the 2 groups . CONCLUSIONS Bicalutamide 150 mg monotherapy may offer an important advantage compared to castration in terms of bone loss and body composition for patients who require long-term and rogen deprivation for localized or locally advanced prostate cancer CONTEXT Survival benefit in the management of high- grade clinical ly localized prostate cancer has been shown for 70 Gy radiation therapy combined with 3 years of and rogen suppression therapy ( AST ) , but long-term AST is associated with many adverse events . OBJECTIVE To assess the survival benefit of 3-dimensional conformal radiation therapy ( 3D-CRT ) alone or in combination with 6 months of AST in patients with clinical ly localized prostate cancer . DESIGN , SETTING , AND PATIENTS A prospect i ve r and omized controlled trial of 206 patients with clinical ly localized prostate cancer who were r and omized to receive 70 Gy 3D-CRT alone ( n = 104 ) or in combination with 6 months of AST ( n = 102 ) from December 1 , 1995 , to April 15 , 2001 . Eligible patients included those with a prostate-specific antigen ( PSA ) of at least 10 ng/mL , a Gleason score of at least 7 , or radiographic evidence of extraprostatic disease . MAIN OUTCOME MEASURES Time to PSA failure ( PSA > 1.0 ng/mL and increasing > 0.2 ng/mL on 2 consecutive visits ) and overall survival . RESULTS After a median follow-up of 4.52 years , patients r and omized to receive 3D-CRT plus AST had a significantly higher survival ( P = .04 ) , lower prostate cancer-specific mortality ( P = .02 ) , and higher survival free of salvage AST ( P = .002 ) . Kaplan-Meier estimates of 5-year survival rates were 88 % ( 95 % confidence interval [ CI ] , 80%-95 % ) in the 3D-CRT plus AST group vs 78 % ( 95 % CI , 68%-88 % ) in the 3D-CRT group . Rates of survival free of salvage AST at 5 years were 82 % ( 95 % CI , 73%-90 % ) in the 3D-CRT plus AST group vs 57 % ( 95 % CI , 46%-69 % ) in the 3D-CRT group . CONCLUSION The addition of 6 months of AST to 70 Gy 3D-CRT confers an overall survival benefit for patients with clinical ly localized prostate cancer To assess testosterone and haemoglobin kinetics in the  Postoperative Adjuvant And rogen Deprivation ( PAAD ) trial , and correlate these with quality of life ( QoL ) in this prospect i ve r and omized study PURPOSE In a r and omized study we compared the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for locally advanced prostate cancer . Patients who were treated only with radiotherapy  initially underwent castration therapy at clinical progression , providing the opportunity to compare immediate vs deferred endocrine intervention . MATERIAL S AND METHODS 
    Output:
    
Early AST probably extends time to death of any cause and time to death from prostate cancer .
It may slightly decrease the rate of skeletal events .
Rates of serious adverse events and quality of life may be similar .
It may increase fatigue and may increase the risk of heart failure .