***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: OBJECTIVES To report an exploratory subgroup analysis assessing the extent to which the overall benefit found in the Early Prostate Cancer program is dependent on lymph node status at r and omization . The program is ongoing , and the overall survival data are immature . The first combined analysis of the bicalutamide ( Casodex ) Early Prostate Cancer program at 3 years ' median follow-up showed that bicalutamide , 150 mg once daily , plus st and ard care ( radical prostatectomy , radiotherapy , or watchful waiting ) , significantly reduced the risk of objective progression and prostate-specific antigen ( PSA ) doubling in patients with localized/locally advanced prostate cancer . METHODS Men ( n = 8113 ) with localized/locally advanced disease received bicalutamide 150 mg or placebo once daily , plus st and ard care . The time to event data ( objective progression , PSA doubling ) was analyzed by lymph node status at r and omization . RESULTS Compared with st and ard care alone , bicalutamide significantly reduced the risk of objective progression , irrespective of lymph node status , with the most pronounced reduction in patients with N+ ( hazard ratio [ HR ] 0.29 ; 95 % confidence interval [ CI ] 0.15 to 0.56 ) compared with those with N0 ( HR 0.59 ; 95 % CI 0.48 to 0.73 ) and Nx ( HR 0.60 ; 95 % CI 0.50 to 0.72 ) disease . The largest decrease in risk of PSA doubling with bicalutamide was observed in N+ disease ( HR 0.16 ; 95 % CI 0.09 to 0.29 ) , with significantly reduced risks seen in N0 ( HR 0.45 ; 95 % CI 0.40 to 0.51 ) and Nx ( HR 0.38 ; 95 % CI 0.33 to 0.44 ) disease . CONCLUSIONS The greatest reduction in the risk of objective progression and PSA doubling with bicalutamide was seen in patients with N+ disease . However , bicalutamide also provided a statistically significant benefit in those with N0 and Nx disease A series of 139 patients with histologically proven stage D1 ( T1 - 3 pN1 - 2 M0 ) prostate cancer was review ed in order to determine the influence of radical surgery in addition to hormonal treatment on long-term outcome with respect to survival and quality of life . In all 139 patients a pelvic lymphadenectomy was performed . In 87 patients , lymphadenectomy was followed by and rogen deprivation alone ( group 1 ) . Fifty-two patients underwent additional radical prostatectomy ( group 2 ) . The actuarial 10-year nonprogression rates were 14.6 % in group 1 and 35.8 % in group 2 , respectively ( p = 0.0016 ) . The overall and disease-specific 10-year survival rates were found to be 29.7 and 32.1 % , respectively , for group 1 and 50.8 and 70.7 % , respectively , for group 2 . Local progression as the main parameter influencing quality of life occurred in 60 of the 87 patients ( 69 % ) not subjected to radical prostatectomy .  Transurethral resection of the prostate was required in 29 of these patients . In contrast , following radical prostatectomy , only 4 of the 52 patients ( 8 % ) had local progression and only 1 patient ( 2 % ) needed a dilatation of the vesicourethral anastomosis for relief of infravesical obstruction . Thus , radical prostatectomy plus and rogen deprivation for patients with stage D1 prostate cancer appeared to be superior to and rogen deprivation alone with respect to survival expectancy and quality of life . Prospect i ve r and omized trials , however , have to be undertaken to verify these results Summary Background Whether the addition of radiation therapy ( RT ) improves overall survival in men with locally advanced prostate cancer managed with and rogen deprivation therapy ( ADT )  is unclear . Our aim was to compare outcomes in such patients with locally advanced prostate cancer . Methods Patients with : locally advanced ( T3 or T4 ) prostate cancer ( n=1057 ) ; or organ-confined disease ( T2 ) with either a prostate-specific antigen ( PSA ) concentration more than 40 ng/mL ( n=119 ) or PSA concentration more than 20 ng/mL and a Gleason score of 8 or higher ( n=25 ) , were r and omly assigned ( done central ly with stratification and dynamic minimisation , not masked ) to receive lifelong ADT and RT ( 65–69 Gy to the prostate and seminal vesicles , 45 Gy to the pelvic nodes ) . The primary endpoint was overall survival . The results presented here are of an interim analysis planned for when two-thirds of the events for the final analysis were recorded . All efficacy analyses were done by intention to treat and were based on data from all patients . This trial is registered at controlledtrials.com as IS RCT N24991896 and Clinical trials.gov as NCT00002633 . Results Between 1995 and 2005 , 1205 patients were r and omly assigned ( 602 in the ADT only group and 603 in the ADT and RT group ) ; median follow-up was 6·0 years ( IQR 4·4–8·0 ) . At the time of analysis , a total of 320 patients had died , 175 in the ADT only group and 145 in the ADT and RT group . The addition of RT to ADT  improved overall survival at 7 years ( 74 % , 95 % CI 70–78 vs 66 % , 60–70 ; hazard ratio [ HR ] 0·77 , 95 % CI 0·61–0·98 , p=0·033 ) . Both toxicity and health-related quality -of-life results showed a small effect of RT on late gastrointestinal toxicity ( rectal bleeding grade > 3 , three patients ( 0·5 % ) in the ADT only group , two ( 0·3 % ) in the ADT and RT group ; diarrhoea grade > 3 , four patients ( 0·7 % ) vs eight ( 1·3 % ) ; urinary toxicity grade > 3 , 14 patients ( 2·3 % ) in both groups ) . Interpretation The benefits of combined modality treatment — ADT and RT — should be discussed with all patients with locally advanced prostate cancer . Funding Canadian Cancer Society Research Institute , US National Cancer Institute , and UK Medical Research Council PURPOSE We assessed pathological outcomes as well as the feasibility of combined docetaxel and and rogen deprivation therapy in men with prostate cancer before undergoing prostatectomy . MATERIAL S AND METHODS In this phase II multicenter study of newly diagnosed patients with untreated clinical ly localized prostate cancer and high risk features , all patients received and rogen deprivation therapy ( 6.3 mg buserelin acetate every 8 weeks for 3 doses and anti and rogen for 4 weeks ) with docetaxel ( 35 mg/m(2 ) weekly for 6 of 8 weeks for 3 doses ) . RESULTS A total of 72 men with a median age of 59 years ( range 46 to 78 ) were enrolled in the study . Baseline characteristics included clinical stage T1C , T2 or T3 in 14 % , 47 % and 39 % , and Gleason score 7 or less , 8 and 9 in 40 % , 29 % and 31 % of patients , respectively . Median baseline prostate specific antigen was 10.8 mug/l ( range 1.6 to 65.6 ) . Eight patients did not complete protocol therapy because of toxicity ( 4 ) , withdrawal of consent ( 1 ) and other reasons ( 3 ) . Of the 64 patients completing protocol therapy 2 had a complete pathological response . Pathological stage was T2 in 53 % and T3 in 44 % of patients . Four patients had N1 disease and positive surgical margins were identified in 27 % . At a median followup of 42.7 months ( range 25.6 to 65.6 ) 19 patients ( 30 % ) had disease relapse . CONCLUSIONS Combined and rogen deprivation and docetaxel before prostatectomy was feasible , and result ed in encouraging recurrence-free survival . While pathological down staging was observed , pathological complete response rates were rare BACKGROUND Mitoxantrone plus prednisone reduces pain and improves the quality of life in men with advanced , hormone-refractory prostate cancer , but it does not improve survival . We compared such treatment with docetaxel plus prednisone in men with this disease . METHODS From March 2000 through June 2002 , 1006 men with metastatic hormone-refractory prostate cancer received 5 mg of prednisone twice daily  and were r and omly assigned to receive 12 mg of mitoxantrone per square meter of body-surface area every three weeks , 75 mg of docetaxel per square meter every three weeks , or 30 mg of docetaxel per square meter weekly for five of every six weeks . The primary end point was overall survival . Secondary end points were pain , prostate-specific antigen ( PSA ) levels , and the quality of life . All statistical comparisons were against mitoxantrone . RESULTS As compared with the men in the mitoxantrone group , men in the group given docetaxel every three weeks had a hazard ratio for death of 0.76 ( 95 percent confidence interval , 0.62 to 0.94 ; P=0.009 by the stratified log-rank test ) and those given weekly docetaxel had a hazard ratio for death of 0.91 ( 95 percent confidence interval , 0.75 to 1.11 ; P=0.36 ) . The median survival was 16.5 months in the mitoxantrone group , 18.9 months in the group given docetaxel every 3 weeks , and 17.4 months in the group given weekly docetaxel . Among these three groups , 32 percent , 45 percent , and 48 percent of men , respectively , had at least a 50 percent decrease in the serum PSA level ( P<0.001 for both comparisons with mitoxantrone ) ; 22 percent , 35 percent ( P=0.01 ) , and 31 percent ( P=0.08 ) had predefined reductions in pain ; and 13 percent , 22 percent ( P=0.009 ) , and 23 percent ( P=0.005 ) had improvements in the quality of life . Adverse events were also more common in the groups that received docetaxel . CONCLUSIONS When given with prednisone , treatment with docetaxel every three weeks led to superior survival and improved rates of response in terms of pain , serum PSA level , and quality of life , as compared with mitoxantrone plus prednisone OBJECTIVES There is no consensus on the management of Stage D1 prostate cancer . The literature suggests that radical prostatectomy , as compared with pelvic lymphadenectomy ( PLND ) alone , may extend survival , Despite evidence that lymph node tumor burden influences cancer survival , few groups of research ers have controlled for this variable when comparing management strategies . We performed a study that was case-controlled for nodal tumor burden to determine if a survival advantage exists for radical prostatectomy . METHODS Of 168 men with Stage D1 disease diagnosed between 1983 and 1995 , 127 underwent pelvic lymphadenectomy and radical retropubic prostatectomy ( PLND/RRP ) and 41 underwent PLND alone .  Clinical charts were review ed for follow-up , and lymph node tumor burden was assessed by volume of nodal metastases and the percentage of positive nodes sample d. Adjuvant treatment was based on the surgeon 's preference and clinical situation . Nineteen patients from each group were matched for age , PSA , Gleason score , clinical stage , follow-up , and nodal tumor burden . RESULTS Comparison of the non-case-controlled PLND/RRP and PLND groups showed no differences in age , prostate-specific antigen level , Gleason score , clinical stage , or follow-up . The nodal tumor burden was greater for the PLND group ( P = 0.001 ) . The 10-year cancer-specific survival rates for the PLND/RRP and PLND groups were statistically different ( P = 0.006 ) . In the case-controlled group , the results were similar for cancer-specific survival at 10 years ( 56 % and 34 % , respectively ; P = 0.09 ) . CONCLUSIONS These data suggest that in Stage D1 prostate cancer , a trend toward a statistical difference in survival may exist for radical prostatectomy as compared with conservative treatment . Further case-controlled and prospect i ve r and omized studies are needed to verify these results PURPOSE Untreated stage pTxN+ prostate cancer is associated with a poor outcome . Monotherapy ( surgery , radiation , hormonal therapy ) alone is associated with a high progression rate . We evaluate whether radical prostatectomy and pelvic lymphadenectomy plus early adjuvant orchiectomy impart a survival advantage compared to pelvic lymphadenectomy and orchiectomy alone in a matched cohort of patients . MATERIAL S AND METHODS Between 1966 and 1995 , 382 and 79 patients with stage pTxN+ prostate cancer underwent pelvic lymph 
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EVIDENCE SYNTHESIS RP can improve progression-free and overall survival in LN-positive PCa , although there is a lack of high-level evidence .
Current data demonstrate that the lymphatic spread takes an ascending pathway from the pelvis to the retroperitoneum , in which the internal and the common iliac nodes represent critical l and marks in the metastatic distribution .
Increasing evidence suggests that RP and extended PLND improve survival in LN-positive PCa .