***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: PURPOSE We identify risk factors for pathological progression among men on active surveillance in the REDEEM ( REduction by Dutasteride of clinical progression Events in Expectant Management trial ) . MATERIAL S AND METHODS REDEEM was a 3-year , r and omized , double-blind study of patients in 65 North American academic centers . Eligible men were 48 to 82 years old , with low risk prostate cancer ( T1c-T2a ) , Gleason score 6 or less , 3 or fewer cores positive , tumor less than 50 % of any 1 core , serum prostate specific antigen 11 ng/ml or less , life expectancy greater than 5 years and undergoing active surveillance . Entry biopsies ( 10 cores or more ) were required . The analysis included 276 patients with 1 biopsy or more after the start of study treatment . Patients received dutasteride 0.5 mg per day or placebo for 3 years . Time to pathological progression ( volume [ 4 or more cores positive or 50 % or greater of 1 core ] or grade progression [ Gleason score 7 or greater ] ) in a post-baseline biopsy ( not preceded by therapeutic intervention ) , and baseline variables were analyzed using a Cox proportional hazard model . RESULTS In total 94 of 276 patients with a post-baseline biopsy ( 34.1 % ) had pathological progression , 54 ( 19.6 % ) had volume progression only , 19 ( 6.9 % ) had grade progression only and 21 ( 7.6 % ) had both types of progression . Older age ( HR 1.05 , 95 % CI 1.01 - 1.08 , p=0.009 ) and higher prostate specific antigen density ( HR 1.06 , 95 % CI 1.04 - 1.09 , p<0.001 ) were associated with pathological progression . Post-baseline prostate specific antigen identified grade , but not volume progression in patients treated with placebo and dutasteride . CONCLUSIONS Older age and higher prostate specific antigen density were independent predictors of pathological progression . Post-baseline measurements as predictors of pathological progression could not be established . Further studies are needed to evaluate the role of dutasteride and establish better markers of pathological progression in active surveillance OBJECTIVE Selection criteria for active surveillance ( AS ) program of localized prostate cancer remain to be st and ardized . The purpose was to evaluate the validity of selection criteria and investigate the feasibility of this AS program . METHODS Patients meeting the criteria ( i ) stage T1cN0M0 , ( ii ) age 50 - 80 , ( iii ) serum prostate-specific antigen ( PSA ) < /=20 ng/ml , ( iv ) one or two positive cores per 6 - 12 systematic biopsy cores , ( v ) Gleason score < /=6 , and ( vi ) cancer involvement in positive core < /=50 % were enrolled and encouraged to start AS for at least 6 months during the period between January 2002 and December 2003 .  PSA  was measured bimonthly for 6 months and every 3 months thereafter . Trigger of treatment recommendation was PSA-doubling time ( PSADT ) of < /=2 years or pathological progression at re-biopsy . Primary endpoint was ' % PSADT > 2y ' , which was defined as the proportion of patients who showed PSADT assessed at 6 months > 2 years out of all the patients who chose AS . Point estimate of ' % PSADT > 2y ' was expected to be > 80 % . RESULTS One hundred and eighteen patients opted for AS and 16 chose immediate treatment at enrollment . PSADT for the initial 6 months based on four measurements could be assessed in 106 patients . Intent-to-treat analysis of ' % PSADT > 2y ' was 71.2 % ( 84/118 , 95 % CI : 62.1 - 79.2 ) . Pathological progression rate at 1-year re-biopsy was 33 % . Fifty-four ( 46 % ) patients remained on AS for maximal observation of 54 months . General health-related QOL in patients undergoing AS was not impaired . CONCLUSIONS The primary endpoint , ' % PSADT > 2y ' , did not meet the pre-specified decision criteria . Further prospect i ve study with revised program and endpoint is needed BACKGROUND In 2008 , we reported that radical prostatectomy , as compared with watchful waiting , reduces the rate of death from prostate cancer . After an additional 3 years of follow-up , we now report estimated 15-year results . METHODS From October 1989 through February 1999 , we r and omly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy .  Follow-up was complete through December 2009 , with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death . Relative risks , with 95 % confidence intervals , were estimated with the use of a Cox proportional-hazards model . RESULTS During a median of 12.8 years , 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died ( P=0.007 ) . In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting , death was due to prostate cancer . This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6 % and 20.7 % , respectively ( a difference of 6.1 percentage points ; 95 % confidence interval [ CI ] , 0.2 to 12.0 ) , and a relative risk with surgery of 0.62 ( 95 % CI , 0.44 to 0.87 ; P=0.01 ) . The survival benefit was similar before and after 9 years of follow-up , was observed also among men with low-risk prostate cancer , and was confined to men younger than 65 years of age . The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age . Among men who underwent radical prostatectomy  , those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth ( relative risk , 6.9 ; 95 % CI , 2.6 to 18.4 ) . CONCLUSIONS Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer . Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment . ( Funded by the Swedish Cancer Society and the National Institutes of Health . ) PURPOSE We assessed risk stratification in patients with low grade prostate cancer managed by active surveillance using a 20-core saturation biopsy technique . MATERIAL S AND METHODS A total of 135 consecutive patients with low risk prostate cancer were prospect ively entered in an active surveillance program  in a 10-year period . The study entrance requirement and progression definition followed Epstein criteria using only pathological parameters , ie fewer than 3 positive cores , Gleason score 6 or less and 50 % or less of any single core involved . All patients were monitored by restaging 20-core saturation biopsy every 12 to 18 months . A total of 120 patients with at least 1 rebiopsy form the basis of this report . RESULTS Of the cohort 30 % progressed during a median of 2.4 years . Three multivariate analyses were performed . The first analysis used variables only at diagnosis biopsy and revealed that prostate specific antigen density greater than 0.08 ng/ml/cc and prostate cancer family history were significant predictors of progression . When combined in a 3-level risk factor score , they were significant ( p = 0.003 ) . The second multivariate analysis considered changes in characteristics between diagnosis biopsy and first rebiopsy . Prostate specific antigen velocity along with prostate specific antigen density and family history highly predicted progression according to a 4-level risk factor score ( p < 0.0001 ) . The third multivariate analysis vali date d the previously reported prostate specific antigen density cutoff of 0.08 ng/ml/cc at first rebiopsy as a significant predictor of subsequent progression ( HR 3.16 , 95 % CI 1.12 , 8.93 ; p = 0.03 ) . CONCLUSIONS Risk factor stratification can be used to significantly predict the outcome in patients on active surveillance .  Prostate specific antigen density 0.08 ng/ml/cc at first rebiopsy was vali date d as a significant predictor of subsequent progression BACKGROUND We sought to identify determinants of health-related quality of life after primary treatment of prostate cancer and to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners . METHODS We prospect ively measured outcomes reported by 1201 patients and 625 spouses or partners at multiple centers before and after radical prostatectomy , brachytherapy , or external-beam radiotherapy .  We evaluated factors that were associated with changes in quality of life within study groups and determined the effects on satisfaction with the treatment outcome . RESULTS Adjuvant hormone therapy was associated with worse outcomes across multiple quality -of-life domains among patients receiving  brachytherapy or radiotherapy . Patients in the brachytherapy group reported having long-lasting urinary irritation , bowel and sexual symptoms , and transient problems with vitality or hormonal function . Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures . After prostatectomy , urinary incontinence was observed , but urinary irritation and obstruction improved , particularly in patients with large prostates . No treatment-related deaths occurred ; serious adverse events were rare . Treatment-related symptoms were exacerbated by obesity , a large prostate size , a high prostate-specific antigen score , and older age . Black patients reported lower satisfaction with the degree of overall treatment outcomes . Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners . CONCLUSIONS Each prostate-cancer treatment was associated with a distinct pattern of change in quality -of-life domains related to urinary , sexual , bowel , and hormonal function . These changes influenced satisfaction with treatment outcomes among patients and their spouses or partners Abstract Introduction Active surveillance ( AS ) is a management strategy for addressing the widely acknowledged problem of over diagnosis and over treatment of clinical ly indolent prostate cancer . Methods A total of 80 patients were enrolled on the AS program in our institution between January 2008 and June 2012 . All data were collected prospect ively in a secure data base . Results The mean age of patients enrolled was 62.7 years ( range 50–72 ) . Median PSA at enrolment was 5.6 ng/mL ( range 1.2–13.4 ) . The mean follow-up was 32 months ( range 2–54 ) . In total , 85 % of patients had a repeat biopsy after 1-year with 30 % having another biopsy after 3 years . Overall , 45 % of patients remain on AS . In the remainder ; 42.5 % of patients have been removed from AS for definitive treatment , while 8.75 % of patients are now on watchful waiting , 2.5 % of patients self discharged from the program and one patient died of cardiovascular disease . The prostate cancer specific survival rate is 100 % . Reasons for removal from AS and referral for treatment were ; 67.6 % of patients had up grade of disease on repeat biopsy , 17.6 % of patients had PSA progression , 11.8 % patients had progression of disease on MRI , and one patient developed a palpable nodule . Regarding definitive treatment ; 52.9 % of patients have been for referred for external beam radiotherapy , 14.7 % have been referred for brachytherapy , 29.4 % have been referred for surgery and one patient has refused definitive treatment . Conclusion Our findings to date support active surveillance as a valid strategy for early , localised prostate cancer Study Type – Diagnostic ( exploratory cohort ) PURPOSE We assessed the feasibility of a watchful waiting protocol with selective delayed intervention using clinical , prostate specific antigen ( PSA ) or histological progression as treatment indications for clinical ly localized prostate cancer . MATERIAL S AND METHODS In this prospect i ve , single arm cohort study patients with favorable clinical parameters ( stage T1b to T2b N0M0 , Gleason score 7 or less and PSA 15 ng./ml . or less ) are conservatively treated with watchful waiting . When a patient meets disease progression criteria , arbitrarily defined by the 3 parameters of the rate of PSA increase , clinical progression or histological up grade on repeat prostate biopsy , appropriate treatment is implemented . Patients are followed every 3 months for the first 2 years and every 6 months thereafter .  Serum PSA measurement and digital rectal examination  are done at each visit and repeat prostate biopsy is performed 18 months after study enrollment . RESULTS Since November 1995 , the study has accrued 206 patients with a median followup of 29 months ( range 2 to 66 ) . Of these men 137 remain on the surveillance protocol with no disease progression , while 69 were withdrawn from study for various reasons . There was clinical , PSA and histological progression in 16 , 15 and 5 cases , respectively . The estimated actuarial probability of remaining on the surveillance protocol was 67 % at 2 years and 48 % at 4 . The probability of remaining progression-free was 81 % and 67 % at 2 and 4 years , respectively . CONCLUSIONS A policy of watch 
    Output:
    
There was evidence that studies including men with the lowest risk disease and scheduled rebiopsy had higher rates of radical treatment