***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: 4 Background : Adjuvant RT for pT3 R1 or R0 patients ( pts . ) after RP remains controversial . The EORTC-phase-III- study suggested a 20 % better biochemical control ( bNED ) after 10 years for RT but no survival advantage . In contrast , the SWOG trial stated not only a gain in bNED but also an improved metastasis free and overall survival after 12 years follow-up . Now , 10-years results from the ARO 96 - 02 study are available , which are based on the most precisely defined cohort among the three trials . METHODS 385 men with prostate cancer were r and omized to either 60 Gy RT ( arm A ; n=193 ) or WS ( arm B ; n=192 )  before achieving an undetectable PSA . Pts . were stratified for Gleason-score , margin status , neoadjuvant hormonal treatment and stage ( pT3a+b vs. c ) . When the undetectable PSA-level after RP was not achieved , progressive disease was stated and the pts . left arm A/B. Data analysis was by intent-to-treat ( ITT ) . PSA-progression for pts . with undetectable post-RP PSA was defined as two consecutive increasing PSA . The primary endpoint was bNED . The study was powered to demonstrate a 15 % increase in bNED for RT . RESULTS 78 pts . ( 20 % ) did not achieve an undetectable PSA and were stated as progressive disease ( arm A : 45 pts . , arm B : 33 pts . ) . Additionally , 34 pts . ( 23 % ) from the RT-arm did not receive RT . Therefore , 114 pts . had RT ( arm A ) and 159 pts . WS ( arm B ) . Median follow up was 111.3 months for arm A and 113.3 months for arm B . bNED at 10 years increased to 56 % for arm A ( RT ) compared with 35 % for arm B ( WS ) ( hazard ratio= 0.51 ; p = 0.00002 . Out of 307 ITT pts . , 15 died from prostate cancer , 23 for other and 5 for unknown reasons . There was no significant profit from ART regarding the endpoints metastasis-free survival ( p=0.56 ) or overall survival ( p=0.59 ) . Worst late side effects to the rectum were two grade 2 cases after ART . Grade ≥2 bladder toxicity occurred in 4 out of 148 ITT pts . No grade 4 events were reported . CONCLUSIONS With only one grade 3 case of late toxicity , ART was safe in pT3 prostate cancer . At 10 years median follow up , it reduced the risk of bNED by 49 % . The study was not powered to detect differences in OS . CLINICAL TRIAL INFORMATION ARO 96 - 02/AUO AP 09/95 BACKGROUND Although there is r and omized evidence that radical prostatectomy improves survival , there are few data on how benefit varies by baseline risk . OBJECTIVE We aim ed to create a statistical model to calculate the decrease in risk of death associated with surgery for an individual patient , using stage , grade , prostate-specific antigen , and age as predictors . DESIGN , SETTING , AND PARTICIPANTS A total of 695 men with T1 or T2 prostate cancer participated in the Sc and inavian Prostate Cancer Group 4 trial ( SPCG-4 ) . INTERVENTION Patients in SPCG-4 were r and omized to radical prostatectomy or conservative management . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing risk models were created separately for the radical prostatectomy and the watchful waiting group , with the difference between model predictions constituting the estimated benefit for an individual patient . RESULTS AND LIMITATIONS Individualized predictions of surgery benefit varied widely depending on age and tumor characteristics . At 65 yr of age , the absolute 10-yr risk reduction in prostate cancer mortality attributable to radical prostatectomy ranged from 4.5 % to 17.2 % for low- versus high-risk patients . Little expected benefit was associated with surgery much beyond age 70 . Only about a quarter of men had an individualized benefit within even 50 % of the mean . A limitation is that estimates from SPCG-4 have to be applied cautiously to contemporary patients . CONCLUSIONS Our model suggests that it is hard to justify surgery in patients with Gleason 6 , T1 disease or in those patients much above 70 yr of age . Conversely , surgery seems unequivocally of benefit for patients who have Gleason 8 , or Gleason 7 , stage T2 . For patients with Gleason 6 T2 and Gleason 7 T1 , treatment is more of a judgment call , depending on patient preference and other clinical findings , such as the number of positive biopsy cores and comorbidities PURPOSE To perform a r and omized trial comparing 70 and 80 Gy radiotherapy for prostate cancer . PATIENTS AND METHODS A total of 306 patients with localized prostate cancer were r and omized . No and rogen deprivation was allowed . The primary endpoint was biochemical relapse according to the modified 1997-American Society for Therapeutic Radiology and Oncology and Phoenix definitions . Toxicity was grade d using the Radiation Therapy Oncology Group 1991 criteria and the late effects on normal tissues-subjective , objective , management , analytic scales ( LENT-SOMA ) scales . The patients ' quality of life was scored using the European Organization for Research and Treatment of Cancer Quality of Life Question  naire 30-item cancer-specific and 25-item prostate-specific modules . RESULTS The median follow-up was 61 months . According to the 1997-American Society for Therapeutic Radiology and Oncology definition , the 5-year biochemical relapse rate was 39 % and 28 % in the 70- and 80-Gy arms , respectively ( p = .036 ) . Using the Phoenix definition , the 5-year biochemical relapse rate was 32 % and 23.5 % , respectively ( p = .09 ) . The subgroup analysis showed a better biochemical outcome for the higher dose group with an initial prostate-specific antigen level > 15 ng/mL. At the last follow-up date , 26 patients had died , 10 of their disease and none of toxicity , with no differences between the two arms . According to the Radiation Therapy Oncology Group scale , the Grade 2 or greater rectal toxicity rate was 14 % and 19.5 % for the 70- and 80-Gy arms ( p = .22 ) , respectively . The Grade 2 or greater urinary toxicity was 10 % at 70 Gy and 17.5 % at 80 Gy ( p = .046 ) . Similar results were observed using the LENT-SOMA scale . Bladder toxicity was more frequent at 80 Gy than at 70 Gy ( p = .039 ) . The quality -of-life question naire results before and 5 years after treatment were available for 103 patients with no differences found between the 70- and 80-Gy arms . CONCLUSION High-dose radiotherapy provided a better 5-year biochemical outcome with slightly greater toxicity PURPOSE Local failure after radiotherapy can arise with cancer extending beyond the capsule and /or involvement of seminal vesicles or positive surgical margins . METHODOLOGY After undergoing radical prostatectomy 1005 patients were r and omly assigned ( 1999 - 2001 ) to a wait and see policy  or an  immediate postoperative irradiation  ( 60 Gy delivered over 6 weeks ) ; eligible patients had pN0 M0 tumors and one or more pathological risk factors mentioned above . The main end-point was 5-year biochemical progression free survival . RESULTS After a median follow-up of 5-year biochemical progression free survival was significantly improved in the irradiated group ( 74 % , 98 % CI : 68.7 - 79.3 vs 52.6 % , 98 % CI : 46.6 - 58.5 ; P<0.0001 ) Clinical progression free survival was also significantly improved ( P<0.0009 ) . The cumulative rate of loco-regional failure was also significantly improved ( P<0.0009 ) . Grade 2 or 3 late effects were significantly more frequent in the postoperative irradiation group ( P=0.0005 ) , but severe toxicity ( grade 3 or higher ) were rare with a 5-year rate of 2.6 % in the wait- and -see group and 4.2 % in the postoperative irradiation group ( P=0.07 ) . CONCLUSION Immediate external irradiation after radical prostatectomy improves biochemical progression free survival and local control in patients with positive surgical margin or pT3 prostate cancer who are at high risk of progression . Further follow-up is needed to assess the impact on overall survival OBJECTIVE To compare early and late side effects in prostate cancer patients with Stage T1b-T3 disease r and omized to receive 70 Gy or 78 Gy .  METHODS There were 189 patients r and omized with a minimum follow-up of 2 years , that were available for this analysis . All patients were initially treated with a 4-field box to an isocenter dose of 46 Gy at 2 Gy per fraction . In the 70-Gy arm , treatment was continued to a reduced volume using a 4-field box technique . In the 78-Gy arm , treatment was continued to a reduced volume using a conformal 6-field arrangement .  Side effects were grade d on a 1 - 4 scale , adapted from Radiation Therapy Oncology Group and Late Effects Normal Tissue Task Force criteria . RESULTS No significant differences in acute rectal or bladder toxicity were seen between the two treatment techniques ( p > 0.6 for all comparisons ) . The 5-year Kaplan-Meier risks of Grade 2 or higher late bladder toxicity were 20 % and 9 % for 70-Gy and 78-Gy groups , respectively ( log rank , p = 0.8 ) . The 5-year risks of Grade 2 or higher late rectal toxicity were 14 % and 21 % for 70 Gy and 78 Gy , respectively ( p = 0.4 ) . Dose-volume histogram analysis of the 78-Gy patients showed a significant correlation between the percentage of rectum irradiated to 70 Gy or greater and the likelihood of developing late rectal complications . Patients with more than 25 % of the rectum receiving 70 Gy or greater had a 5-year risk of Grade 2 or higher complications of 37 % compared to 13 % for patients with 25 % or less ( p = 0.05 ) . All three Grade 3 complications occurred when greater than 30 % of the rectum received 70 Gy or more . CONCLUSION The overall rate of complications was similar in both treatment arms . However , there is evidence for a significant increase in late rectal complications when more than 25 % of the rectum received 70 Gy or greater . This parameter may serve as a benchmark for the design of future three-dimensional conformal trials Abstract There were 97 patients with clinical stage A2 or B ( T1 - 2N0M0 ) prostatic adenocarcinoma and normal serum prostatic acid phosphatase levels , negative isotopic bone scans and no pelvic nodal extension as determined by staging pelvic lymphadenectomy assigned r and omly to either radical prostatectomy or megavoltage radiation therapy . While 56 patients received radiation , 41 underwent radical prostatectomy . With time to first evidence of treatment failure used as the end point for determination of treatment efficacy , radical prostatectomy was shown to be more effective than megavoltage radiation in establishing disease control PURPOSE To compare the toxicity between hypofractionation vs. conventional fractionation schedules in patients with high-risk prostate cancer . METHODS AND MATERIAL S Between January 2003 and December 2007 , 168 patients were r and omized to receive either hypofractionated ( 62 Gy in 20 fractions within 5 weeks , 4 fractions/wk ) or conventionally fractionated ( 80 Gy in 40 fractions within 8 weeks ) three-dimensional conformal radiotherapy to the prostate and seminal vesicles . All patients had undergone a 9-month course of total and rogen deprivation , with radiotherapy starting 2 months after initiation of the total and rogen deprivation . RESULTS The median follow-up was 32 and 35 months in the hypofractionation and conventional fractionation arms , respectively . For the patients developing acute toxicity , no difference between the two fractionation groups was found in either severity or duration of gastrointestinal or genitourinary toxicity . Also , no difference was found in the incidence and severity of late gastrointestinal and genitourinary toxicity between the two treatment schedules , with a 3-year rate of Grade 2 or greater toxicity of 17 % and 16 % for the hypofractionation arm and 14 % and 11 % for the conventional fractionation arm , respectively . A statistically significant correlation between acute and late gastrointestinal toxicity was found only in the conventional fractionation group . CONCLUSION Our findings suggest that the hypofractionation regimen used in our study is safe , with only a slight , nonsignificant increase in tolerable and temporary acute toxicity compared with the conventional fractionation schedule . The severity and frequency of late complications was equivalent between the two treatment groups PURPOSE To compare 
    Output:
    
EBRT , BT and RP were found to be effective in the management of localised prostate cancer .
While higher doses of EBRT seem to be related to favourable survival-related outcomes they might , depending on technique , involve more adverse events , e.g. gastrointestinal and genitourinary toxicity .
Aside from mixed findings regarding urinary function , BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function .
There might be advantages of EBRT ( with/without HT ) compared to cryoablation ( with/without HT ) .
Based on this systematic review , there is no strong evidence to support one therapy over another as EBRT , BT and RP can all be considered as effective monotherapies for localised disease with EBRT also effective for post-operative management .
All treatments have unique adverse events profiles .