***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 
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    Input: OBJECTIVES Treatment failure after radical prostatectomy is most commonly heralded by an increase in serum prostate-specific antigen ( PSA ) to detectable levels . We evaluated the clinical utility of an ultrasensitive chemiluminescent PSA assay . METHODS We evaluated the assay in banked sera obtained from 170 men after radical prostatectomy . Controls consisted of 142 females , 29 men who had undergone cystoprostatectomy without evidence of prostate cancer , and 25 men without evidence of recurrent disease at least 5 years after prostatectomy for organ-confined disease .  Lead time to diagnosis of recurrence was based on comparisons with the IMx or T and em E assays using a cutoff of 0.1 ng/mL ( 100 pg/mL ) . RESULTS The biologic level of detection of this assay is 8 pg/mL. Serum PSA levels were undetectable in 82.4 % of females , 86.2 % of the cystoprostatectomy patients , and 96 % of the radical prostatectomy controls . After radical prostatectomy , PSA levels were undetectable at last check in 104 of 168 ( 61.9 % ) men . In the 24 men with prostate cancer recurrence , the enhanced sensitivity of 8 pg/mL provided a mean lead time based on conservative calculations of 12.7 to 22.5 months over conventional assays . Thirty-four of the 41 men with detectable PSA levels and no evidence of disease recurrence had PSA levels of 30 pg/mL or less . CONCLUSIONS PSA levels are undetectable in most men who do not have recurrence of disease after radical prostatectomy . Low but detectable serum PSA levels less than or equal to 30 pg/mL can be produced by nonmalignant sources of PSA . PSA assays with enhanced sensitivity can detect recurrent prostate cancer with significant lead time over conventional assays Objectives In this study , we evaluate the outcomes of salvage cryotherapy for locally recurrent prostate cancer within the COLD ( cryo online data ) Registry . Furthermore , we assess the results of salvage cryotherapy ( with intermediate follow-up ) stratified by pre-treatment prostate-specific antigen ( PSA ) levels to determine which patients may best be suited for treatment . Methods The COLD registry was developed as a prospect i ve , central ly collected data base among patients undergoing salvage cryoablation for locally recurrent prostate cancer following primary prostate radiotherapy with curative intent . Of the patients undergoing salvage cryotherapy ( without neoadjuvant hormonal ablative therapy ) , complete medical records were available in 156 patients , with their mean follow-up being 3.8 years ( 0.9–12.7 years ) . The treatment outcomes of salvage cryotherapy were assessed using the Phoenix definition ( nadir PSA + 2 ng/ml ) of biochemical failure . Results Of our entire study population , the biochemical disease-free survival ( bDFS ) rates at 1 , 2 , and 3 years were 89.0 , 73.7 , and 66.7 % , respectively . Stratification of our patients into two subgroups is based on their pre-treatment total serum PSA values < 5 and ≥5 ng/ml , and bDFS rates at 3 years for these two subgroups were 78.3 and 52.9 % , respectively . A Kaplan – Meier analysis of bDFS stratified by these same pre-treatment PSA values revealed that the subset of patients with a PSA ≥ 5 ng/ml had statistically significant poorer bDFS rates ( P = 0.01 ) . Conclusions Salvage prostate cryotherapy is a potentially curative local salvage therapy . The importance of early referral when patients have a pre-treatment PSA < 5 ng/ml is essential to optimize treatment outcomes PURPOSE High intensity focused ultrasound for the treatment of primary prostate cancer is increasing in a subset of men seeking definitive treatment with reduced morbidity . We review outcomes in men undergoing salvage radical prostatectomy after failed whole gl and high intensity focused ultrasound .  MATERIAL S AND METHODS Prospect i ve data were collected for men presenting with an increasing prostate specific antigen and biopsy proven prostate cancer after high intensity focused ultrasound from 2007 to 2010 who underwent salvage open radical prostatectomy with a 22-month median followup , including prostate specific antigen , prostate volume , pathology results , continence and erectile function . RESULTS Data for 15 men were available , including median age 64 years ( IQR 55 - 69 ) , Gleason score before high intensity focused ultrasound of 6 ( 8) , Gleason score 7 ( 7 ) , median cores positive 39 % ( IQR 17%-63 % ) and median prostate specific antigen 7 ng/ml ( IQR 5 - 8 ) . Whole gl and high intensity focused ultrasound achieved median nadir prostate specific antigen 1.1 ng/ml ( IQR 0.5 - 3.1 ) . Biopsy after high intensity focused ultrasound demonstrated Gleason score 6 ( in 3 patients ) , 7 ( 9 ) and 8/9 ( 3 ) , and 42 % ( IQR 25%-50 % ) cores positive and a median time from high intensity focused ultrasound to radical prostatectomy of 22 months ( IQR 7 - 26 ) . Perioperative morbidity was limited to 1 transfusion in a patient with a rectal injury . Pathologically extensive periprostatic fibrosis was found with persistent prostate cancer , as pT3 disease ( in 9 of 14 ) , Gleason scores 6 ( 2 ) , 7 ( 9 ) and 8 of 9 ( 4 ) , with focally positive margins in 3 of 11 ( pT3a ) . Postoperative prostate specific antigen was unrecordable in 14 of 15 patients with further treatment in 2 . Postoperative continence ( more than 12 months of followup ) yielded no pad use in 6 of 10 men with universally poor erectile function . CONCLUSIONS Radical prostatectomy as salvage is feasible for men in whom high intensity focused ultrasound failed , but with a higher morbidity than for primary surgery . Pathology results are alarming given the number of cases with extraprostatic extension yet early followup data suggest acceptable oncologic control . These results should be factored in when counseling men who wish to undergo primary high intensity focused ultrasound CONTEXT Biochemical disease recurrence after radical prostatectomy often prompts salvage radiotherapy , but no studies to date have had sufficient numbers of patients or follow-up to determine whether radiotherapy improves survival , and if so , the subgroup of men most likely to benefit . OBJECTIVES To quantify the relative improvement in prostate cancer-specific survival of salvage radiotherapy vs no therapy after biochemical recurrence following prostatectomy , and to identify subgroups for whom salvage treatment is most beneficial . DESIGN , SETTING , AND PATIENTS Retrospective analysis of a cohort of 635 US men undergoing prostatectomy from 1982 - 2004 , followed up through December 28 , 2007 , who experienced biochemical and /or local recurrence and received no salvage treatment ( n = 397 ) , salvage radiotherapy alone ( n = 160 ) , or salvage radiotherapy combined with hormonal therapy ( n = 78 ) . MAIN OUTCOME MEASURE Prostate cancer-specific survival defined from time of recurrence until death from disease . RESULTS With a median follow-up of 6 years after recurrence and 9 years after prostatectomy , 116 men ( 18 % ) died from prostate cancer , including 89 ( 22 % ) who received no salvage treatment , 18 ( 11 % ) who received salvage radiotherapy alone , and 9 ( 12 % ) who received salvage radiotherapy and hormonal therapy . Salvage radiotherapy alone was associated with a significant 3-fold increase in prostate cancer-specific survival relative to those who received no salvage treatment ( hazard ratio [ HR ] , 0.32 [ 95 % confidence interval { CI } , 0.19 - 0.54 ] ; P<.001 ) . Addition of hormonal therapy to salvage radiotherapy was not associated with any additional increase in prostate cancer-specific survival ( HR , 0.34 [ 95 % CI , 0.17 - 0.69 ] ; P = .003 ) . The increase in prostate cancer-specific survival associated with salvage radiotherapy was limited to men with a prostate-specific antigen doubling time of less than 6 months and remained after adjustment for pathological stage and other established prognostic factors . Salvage radiotherapy initiated more than 2 years after recurrence provided no significant increase in prostate cancer-specific survival .  Men whose prostate-specific antigen level never became undetectable after salvage radiotherapy did not experience a significant increase in prostate cancer-specific survival .  Salvage radiotherapy also was associated with a significant increase in overall survival . CONCLUSIONS Salvage radiotherapy administered within 2 years of biochemical recurrence was associated with a significant increase in prostate cancer-specific survival among men with a prostate-specific antigen doubling time of less than 6 months , independent of other prognostic features such as pathological stage or Gleason score . These preliminary findings should be vali date d in other setting s , and ultimately , in a r and omized controlled trial PURPOSE Hormonal therapy ( HT ) is the current mainstay of systemic treatment for prostate specific antigen ( PSA ) only recurrence ( PSAR ) , however , there is virtually no published literature comparing HT to observation in the clinical setting . The goal of this study was to examine the Department of Defense Center for Prostate Disease Research observational data base to compare clinical outcomes in men who experienced PSAR after radical prostatectomy by early versus delayed use of HT and by a risk stratified approach . MATERIAL S AND METHODS Of 5,382 men in the data base who underwent primary radical prostatectomy ( RP ) , 4,967 patients were treated in the PSA-era between 1988 and December 2002 . Of those patients 1,352 men who had PSAR ( PSA after surgery greater than 0.2 ng/ml ) and had postoperative followup greater than 6 months were used as the study cohort . These patients were further divided into an early HT group in which patients ( 355 ) received HT after PSA only recurrence but before clinical metastasis and a late HT  group for patients ( 997 ) who received no HT before clinical metastasis or by current followup . The primary end point was the development of clinical metastases . Of the 1,352 patients with PSAR  clinical metastases developed in 103 ( 7.6 % ) . Patients were also stratified by surgical Gleason sum , PSA doubling time and timing of recurrence . Univariate and multivariate Cox proportional hazard models were used to evaluate the effect of early and late HT on clinical outcome . RESULTS Early HT was associated with delayed clinical metastasis in patients with a pathological Gleason sum greater than 7 or PSA doubling time of 12 months or less ( Hazards ratio = 2.12 , p = 0.01 ) . However , in the overall cohort early HT did not impact clinical metastases . Race , age at RP and PSA at diagnosis had no effect on metastasis-free survival ( p > 0.05 ) . CONCLUSIONS The retrospective observational multicenter data base analysis demonstrated that early HT administered for PSAR after prior RP was an independent predictor of delayed clinical metastases only for high-risk cases at the current followup . Further study with longer followup and r and omized trials are needed to address this important issue RADICALS is a large , international r and omised controlled trial addressing two of the most important questions in postoperative management after radical prostatectomy : the timing of postoperative radiotherapy ( immediate vs early salvage ) and the duration of hormone therapy ( none vs short term vs long term ) used in addition to prostate bed radiotherapy . It has been funded by the Clinical Trials Awards Advisory Committee and will be run by the Medical Research Council Clinical Trials Unit , in collaboration with the National Cancer Institute of Canada Clinical Trials Group and the Trial Management Group . Additional international collaborative groups are also being invited to take part . RADICALS is an ambitious trial , aim ing to recruit over 4000 patients . Widespread support from the urological and oncological communities will be required . More information relating to this study is available from the Medical Research Council Clinical Trials Unit via : radicals@ctu.mrc.ac.uk . © 2007 The Royal College of Radiologists PURPOSE Salvage radical prostatectomy is associated with a higher complication rate than radical prostatectomy without prior radiotherapy but the magnitude of the increase is not well delineated . MATERIAL S AND METHODS A total of 3,458 consecutive patients underwent open radical prostatectomy and 98 underwent open salvage radical prostatectomy from January 1999 to June 2007 . Data were collected from prospect i ve surgical and institutional morbidity data bases , and retrospectively from billing records and medical records . Medical and surgical complications were captured , grade d by the modified Clavien classification and classified by time of onset . RESULTS Median followup after salvage radical prostatectomy and radical prostatectomy was 34.5 and 45.5 months , respectively . Patients with salvage had significantly higher median age , modified Charlson comorbidity score , clinical and pathological stage , and Gleason score . They were less likely to have organ confined disease and more likely to have seminal vesicle invasion and nodal metastasis . There was no significant difference in median operative time , blood loss or transfusion rate . The salv 
    Output:
    
The most common option for local salvage therapy after radical prostatectomy ( RP ) was radiation .
Options for local salvage therapy after primary radiation included RP , brachytherapy , and cryotherapy .
Radiation therapy ( RT ) after RP can provide durable prostate-specific antigen ( PSA ) responses in a sizeable percentage of men , especially when given early ( ie , PSA < 1 ng/ml ) .
The role of salvage treatment after RT is less clear