***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: BACKGROUND The currently recommended frequency for prostate-specific antigen ( PSA ) screening tests for prostate cancer is 1 year , but the optimal screening interval is not known . Our goal was to determine if a longer interval would compromise the detection of curable prostate cancer . METHODS A cohort of 4491 men aged 55 - 75 years , all participants in the Rotterdam section of the European R and omized Study of ( population -based ) Screening for Prostate Cancer , were invited to participate in an initial PSA screening .  Men who received that screening were invited for a second screen 4 years later . Pathology findings from needle biopsy cores were compared for men in both rounds . Statistical tests were two-sided . RESULTS A total of 4133 men were screened in the first round ( the prevalence screen ) , and 2385 were screened in the second round . The median amount of cancer in needle biopsy sets was 7.0 mm ( 95 % confidence interval [ CI ] = 5.4 mm to 8.6 mm ) in the first round and 4.1 mm ( 95 % CI = 2.6 mm to 5.6 mm ) in the second round ( P = .001 ) . Thirty-six percent of the adenocarcinomas detected in the first round but only 16 % of those detected in the second round had a Gleason score of 7 or higher ( mean difference = 20 % [ 95 % CI = 10 % to 30 % ] ; P<.001 ) . Whereas 25 % of the adenocarcinomas detected in the first round had adverse prognostic features , only 6 % of those detected in the second round did ( mean difference = 19 % [ 95 % CI = 11 % to 26 % ] ; P<.001 ) . Baseline PSA values were predictive for the amount of tumor in biopsies in men with cancer in the first round but not for that in the second round . CONCLUSION Most large prostate cancers with high serum PSA levels were effectively detected in a prevalence screen . In this population , a screening interval of 4 years appears to be short enough to constrain the development of large tumors , although it is inconclusive whether this will result in a survival benefit The objective was to investigate how prostate cancer and its treatment affects sexual , urinary and bowel functions and to what extent eventual complications cause distress . A question naire was sent to 431 men aged 50 - 80 years with prostate cancer diagnosed in 1992 in the Stockholm area ( Sweden ) and 435 r and omly selected men with a similar age distribution .  Sexual function , as compared with their youth , was diminished in a majority of all men . The prostate cancer patients were , however , more likely to report low frequency and /or intensity in all aspects of sexual function . A majority of the men were distressed by a waning sexual capacity . The proportion of men with prostate cancer who were severely distressed owing to a decline in sexual function was larger than in the reference group . The willingness to trade off an intact sexual function for long-term survival varied considerably among the men in the reference group . Urinary and bowel symptoms were less common than a waning sexual function in both groups , and few appeared to be severely distressed by urinary or bowel symptoms . A decline in sexual functions was the most common cause of disease-specific distress in men with prostate cancer OBJECTIVE To describe the incidence , time to onset and extent of anaemia occurring in patients with prostate cancer receiving combined hormone blockade ( CHB )  and the timing and extent of recovery from anaemia in those patients where CHB was discontinued . PATIENTS AND METHODS Patients with prostate cancer were evaluated prospect ively by physical examination and laboratory tests at baseline and at routine intervals while receiving CHB . Of 142 patients who received CHB , 133 were evaluable for the assessment of anaemia ;  CHB was discontinued in 76 patients , of whom 64 were assessable for recovery from their anaemia . RESULTS Haemoglobin levels declined significantly in all patients from a mean baseline of 149 g/L to means of 139 g/L , 132 g/L and 131 g/L at 1 , 2 and 3 months , respectively . Haemoglobin levels continued to decline during CHB to a mean nadir of 123 g/L at a mean of 5.6 months of CHB , representing a mean absolute haemoglobin decline at nadir of 25.4 g/L. In 120 of the 133 ( 90 % ) patients , the relative decline in haemoglobin at nadir was > or = 10 % and was > or = 25 % in 17 ( 13 % ) others , representing a mean absolute haemoglobin decline in this subset of 42.7 g/L. Significant symptoms related to anaemia occurred in 17 patients ( 13 % ) . Anaemia and symptoms in these patients were easily corrected with the subcutaneous administration of recombinant human erythropoietin . CONCLUSIONS The anaemia associated with and rogen deprivation is significant and occurs routinely in men receiving CHB .  It is normochromic , normocytic , temporally-related to the initiation of and rogen blockade and usually resolves after CHB is discontinued . We suggest that patients receiving CHB undergo haematological testing at baseline , 1 - 2 months after initiating CHB and periodically thereafter . Patients developing anaemia should be question ed about symptoms reflecting physiological compromise ( e.g. angina , dyspnoea on exertion ) . In the absence of other causes , CHB should be suspected in the development of anaemia in patients receiving this treatment BACKGROUND Most studies that have described the sensitivity and specificity of prostate-specific antigen ( PSA ) as a screening test have been conducted in urology practice setting s or in media-based screening programs . The control patients from these setting s may have a higher prevalence of urologic disorders that increase serum PSA levels than that of the general population in which screening efforts might take place , leading to biased estimates of sensitivity and specificity . OBJECTIVE To determine the sensitivity and specificity of  serum PSA levels  for the early detection of prostate cancer in a population -based setting . PATIENTS AND METHODS This population -based case-control study was conducted in Olmsted County , Minnesota , where the Rochester Epidemiology Project could identify all incident cases of prostate cancer through passive surveillance of medical care provided to local residents . Case patients were all 177 men ( age range , 50 - 79 years ) who were newly diagnosed as having prostate cancer from 1990 through 1992 and had a prediagnostic serum PSA determination ( 90 % of all incident cases ) . Control patients were r and omly selected from the Olmsted County population and had undergone a clinical examination to exclude prostate cancer . RESULTS The median ( 25th and 75th percentiles ) of serum PSA levels was 9.4 ng/mL ( 5.4 and 18.6 ng/mL , respectively ) for case patients and 1.2 ng/mL ( 0.7 and 2.1 ng/mL , respectively ) for control patients ( P < .001 ) . When sensitivity was plotted against 1-specificity , the area under the receiver operating characteristic curve was 0.94 ( SE , 0.01 ) . The predictive power declined somewhat with age , with areas under the curve of 0.96 , 0.94 , and 0.90 for men in their 50s , 60s , and 70s , respectively . When cases were restricted to the 155 men with clinical ly localized disease , the area under the curve was essentially unchanged ( 0.94 ; SE , 0.01 ) and still much greater than the estimates of 0.75 that were reported from urology practice - and media-based setting s. CONCLUSIONS In a community-based setting , serum PSA levels provide better discrimination between men with and without clinical ly localized prostate cancer than has been observed in studies that were conducted in urologic practice s. These results suggest that previous decision analyses may have underestimated the predictive value of PSA for the detection of prostate cancer in a primary care or community-wide screening program OBJECTIVES To evaluate the effect of immediate and rogen suppression in conjunction with st and ard external beam irradiation ( RT ) versus RT alone on a group of men after prostatectomy who had indications for adjuvant treatment . METHODS A national prospect i ve r and omized trial ( Radiation Therapy Oncology Group [ RTOG ] 85 - 31 ) comparing st and ard external beam RT plus immediate and rogen suppression versus external beam RT alone with delayed hormonal treatment at relapse was initiated for patients with locally advanced adenocarcinoma of the prostate . One hundred thirty-nine of the patients in this trial had indications for adjuvant treatment after prostatectomy ( eg , capsular penetration , seminal vesicle involvement ) . Seventy-one of the patients received RT with immediate and rogen suppression ( luteinizing hormone-releasing hormone [ LHRH ] agonist ) ;  68 patients received RT alone with hormonal manipulation instituted only at the time of relapse . RESULTS With a median follow-up of 5 years , the estimated progression-free survival rate ( failure defined as prostate-specific antigen [ PSA ] greater than 0.5 ng/mL ) was 65 % for the men who received combination therapy and 42 % for those treated by RT alone with hormones reserved for relapse ( P = 0.002 ) . Differences in the rates of freedom from biochemical relapse were observed when failure was defined as PSA of 1.0 to 3.9 ng/mL ( 71 % versus 46 % ; P = 0.008 ) and PSA greater than 4.0 ng/mL ( 76 % versus 55 % ; P = 0.05 ) , respectively . No differences were observed between the groups with respect to the end points of local control , distant failure , and overall survival . The use of immediate and rogen suppression ( ie , LHRH agonists ) and the absence of pathologic nodal involvement were independently associated with prolongation of freedom from biochemical relapse by multivariate analysis . CONCLUSIONS Patients with prostate cancer and indications for postoperative RT should be considered for combined RT and hormonal manipulation . Because statistically significant advantages for this experimental approach could not be defined for all end points studied ( in particular , overall survival ) , efforts should be made to enroll these patients in the recently activated RTOG trial ( 96 - 01 ) comparing RT plus placebo to the combination of RT plus Casodex in the postoperative setting BACKGROUND The utility of digital rectal examination ( DRE ) as a screening test for early detection of prostate cancer has not been established . Therefore , we evaluated the usefulness of DRE as a st and -alone screening test and in conjunction with measured serum prostate-specific antigen ( PSA ) levels of 0 - 3.9 ng/mL and transrectal ultrasonography ( TRUS ) . METHODS Our study population consisted of 10,523 men aged 54 - 76 years who were r and omly assigned to the screening arm of the Rotterdam , The Netherl and s , section of the European R and omized Study of Screening for Prostate Cancer . The underlying prevalence of detectable prostate cancer was estimated by logistic regression analysis and used for calculating the sensitivity of DRE as a test . Pathologic characteristics of 105 radical prostatectomy specimens were used to determine the aggressiveness of the tumors diagnosed ( and missed ) by DRE . RESULTS The overall detection rate for prostate cancer in this population when serum PSA measurement , DRE , and TRUS were used was 4.5 % , and the detection rate with DRE alone was 2.5 % . The positive predictive value of DRE  ranged from 4 % to 11 % in men with PSA levels of 0 - 2.9 ng/mL and from 33 % to 83 % in men with PSA levels of 3.0 - 9.9 ng/mL or more . Most tumors detected by DRE in men with PSA levels of less than 4.0 ng/mL were small ( mean volumes = 0.24 - 0.83 mL ) , and most were well differentiated ( Gleason scores of 6 or less ) . Minimal , moderate , and advanced cancers were seen in 42 % , 42 % , and 16 % of men , respectively , with a PSA level of 4.0 ng/mL or less . DRE alone allowed detection of 264 ( 55.8 % ) of 473 cancers ; 82 ( 17.3 % ) of the 473 cancers would have remained undetected by PSA-based screening alone ( i.e. , no follow-up procedures for PSA values of 0 - 3.9 ng/mL ) . CONCLUSIONS For PSA values of 0 - 3.9 ng/mL , the positive predictive value and sensitivity of DRE , tumor volume , and tumor grade were strongly dependent on PSA level . DRE has a poor performance in low PSA ranges It has been noted that the most important evidence for a benefit of early detection of prostate cancer using prostate-specific antigen ( PSA ) testing would be a decline in prostate cancer mortality rates to levels below those existing before diagnostic use of PSA testing . We document a decrease in U.S. prostate cancer mortality rates in white men less than 85 years of age to levels below those existing in 1986 , the year use of PSA testing was approved . In fact , for men 60 - 79 years of age , prostate cancer mortality rates were lower in 1997 than in any year since 1950 . Although it has been argued that the decrease in prostate cancer mortality rates began too soon to be explained by PSA testing , stage-specific survival rates indicate 
    Output:
    
Important trends in prostate cancer incidence and mortality also occurred at that time .
Disease-specific mortality rates paralleled trends in prostate cancer incidence ( 15 , 16 ) .
The argument that the decline in mortality can be attributed to PSA screening would be stronger if it could be shown that the decline was largest in areas with more screening .
Currently available prognostic markers can distinguish a small number of men with excellent prognosis for long-term survival and a small number of men with