***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: Forty-two patients with previously untreated T3/4 N1 - 4 MO/1 prostatic adenocarcinoma were treated with either cyproterone acetate ( n = 21 ; 300 mg intramuscularly per week ) or oestradiol undecylate ( n = 21 ; 100 mg intramuscularly per month ) after extensive staging which included open skeletal biopsy and pelvic lymphadenectomy in some cases . Subjective and objective parameters as well as signs of drug toxicity were recorded regularly . Evaluation after 6 months showed cyproterone acetate to be more effective in the following respects : ( 1 ) the significantly different castration effect as judged by plasma testosterone , ( 2 ) the objective voiding pattern and tumour response , with regression of palpable and histologically evaluable local tumour in 16 of 21 patients , and ( 3 ) side effects and untoward reactions . Thus cyproterone acetate is suggested as a valuable alternative in the treatment of advanced prostatic cancer 151 patients with locally advanced prostatic cancer ( T3 - 4 M0 ) , representing 38 % of the 404 cancer patients in a Finnish multicenter study , were r and omly assigned to one of three treatment arms : orchiectomy , estrogens or radiotherapy . During the 4-year follow-up period there were no significant differences in the progression rates ( appearance of metastases in bone scan ) between the therapy groups . The frequency of thromboembolic and other cardiovascular complications was highest in the estrogen group ( 13/50 patients ) . In the radiotherapy group , 19 of 45 patients had bowel or bladder complications . On the other h and , orchiectomy has few , if any , complications . The high risk of complications associated with estrogens and radiotherapy has to be taken into consideration in the selection of treatment Thirty previously untreated patients with carcinoma of the prostate were prospect ively r and omised to one of the following treatments : ethinyl oestradiol ( Etivex ) combined with polyoestradiol phosphate ( Estradurin ) ; estramustine phosphate ( Estracyt ) ; bilateral orchiectomy .  Oestrogenic effects were measured by blood levels of pregnancy zone protein , sex hormone binding globulin , LH , FSH and prolactin . During a follow-up period of 6 months , estramustine phosphate and ethinyl oestradiol/polyoestradiol phosphate induced comparable changes in these proteins , suggesting comparable oestrogenic effects of these two forms of treatment in patients with prostatic carcinoma The authors made a r and omized prospect i ve study of estrogen therapy versus orchidectomy in patients with prostatic cancer ( n = 100 , Huddinge Hospital , Sweden ) to investigate the possibility of predicting cardiovascular events during hormonal treatment . Patients with preexisting cardiovascular morbidity were excluded ( 16 % ) . Prior to the allocation of therapy , the following were performed : exercise stress test  ; physiologic evaluation of the peripheral circulation ; blood volume estimation ; chest x-ray ; blood tests , including  hormones , lipoproteins  , and  antithrombin III ; and a physical examination and history by a cardiologist .  Thirteen ( 25 % ) of the patients given estrogen therapy ( n = 53 ) had cardiovascular complications during the first year of treatment compared with none in the orchidectomy group . The authors made a multivariate discriminant analysis of the pretreatment examinations of the  estrogen-treated  patients ; this result ed in a discriminant function including S-T segment depression in lead CH2 during the exercise stress test and blood tests for cholesterol , follicle-stimulating hormone , and luteinizing hormone . This function correctly classified 84 % of the estrogen-treated patients as patients with or without risk of a cardiovascular complication . Briefly stated , if patients with prostatic cancer are examined by means of exercise  stress  tests and blood tests for luteinizing hormone , cholesterol , and follicle-stimulating hormone prior to treatment , the discriminant function enables the authors to identify an extremely high-risk group for cardiovascular complications if estrogen therapy is commenced . The strong association of an increased luteinizing hormone with cardiovascular complications during estrogen treatment makes it m and atory to investigate its role in the pathogenesis of atherosclerosis and cardiovascular events BACKGROUND Mortality increases after hip fractures  in women and more so in men . Little is known , however , about mortality after other fractures . We investigated the mortality associated with all fracture types in elderly women and men . METHODS We did a 5-year prospect i ve cohort study  in the semi-urban city of Dubbo , Australia , of all residents aged 60 years and older ( 2413 women and 1898 men ) . Low-trauma  osteoporotic fractures that occurred between 1989 and 1994 , confirmed by radiography  and personal interview , were classified as proximal femur , vertebral , and groupings of other major and minor fractures . We calculated st and ardised mortality rates from death certificates for people with fractures compared with the Dubbo population . FINDINGS 356 women and 137 men had low-trauma fractures . In women and men , mortality was increased in the first year after all major fractures . In women , age-st and ardised mortality ratios were 2.18 ( 95 % CI 2.03 - 2.32 ) for proximal femur , 1.66 ( 1.51 - 1.80 ) for vertebral , 1.92 ( 1.70 - 2.14 ) for other major , and 0.75 ( 0.66 - 0.84 ) for minor fractures . In men , these ratios were 3.17 ( 2.90 - 3.44 ) for proximal femur , 2.38 ( 2.17 - 2.59 ) for vertebral , 2.22 ( 1.91 - 2.52 ) for other major , and 1.45 ( 1.25 - 1.65 ) for minor fractures . There were excess deaths ( excluding minor fractures in women ) in all age-groups . INTERPRETATION All major fractures were associated with increased mortality , especially in men . The loss of potential years of life in the younger age-group shows that preventative strategies for fracture should not focus on older patients at the expense of younger women and of men BACKGROUND The present pilot study tested the clinical performance of a new pharmacokinetically guided dosing regimen of parenteral estrogen in patients with advanced prostatic carcinoma . The aim was to accelerate endocrine effects and to avoid cardiovascular side effects . METHODS Seventeen patients were r and omized to intramuscular injections of  240 mg polyestradiol phosphate ( PEP ) every second week for the first 8 weeks ( five doses ) , followed by a maintenance dose of 240 mg every month ; and 16 patients were r and omized to bilateral orchidectomy .  The estrogen dosing was calculated by pharmacokinetic modelling to achieve a rapid increase in serum estradiol and thereby a fast decrease in testosterone . RESULTS The predicted increment in serum estrogen was achieved , together with a subsequent decrease in testosterone in the PEP group . In addition , there were no signs of an increased cardiovascular morbidity . This was probably due to a minimal estrogenic influence on the liver and was reflected by unchanged levels of coagulation factor VII . Clinical effects , during the first 2 years of treatment , were similar in the two treatment arms , with 12 patients in the orchidectomy group and 14 patients in the PEP group responding to treatment . CONCLUSIONS The present parenteral regimen is an efficient and time-saving  estrogen regimen with a favorable side-effect profile . PEP seems to offer a potential for revival of the most cost-effective endocrine treatment of cancer of the prostate , i.e. , estrogen OBJECTIVE To evaluate the clinical efficacy and cardiovascular complications of orchidectomy or polyoestradiol phosphate ( PEP ) in the treatment of advanced prostatic cancer . PATIENTS AND METHODS In a prospect i ve , r and omized study 444 patients ( mean age 73 years , range 45 - 91 ) with T3 - 4 M0 or T1 - 4 M1 prostatic cancer were treated either by orchidectomy  ( group 1 , n = 217 ) or  parenteral PEP  ( group 2 , n = 227 ; 240 mg/month ) . The patients were examined at 3 and 6 months after start of the therapy and thereafter every 6 months ; they were also assessed whenever they had symptoms indicating progression . Possible cardiovascular complications included myocardial infa rct ion , cerebrovascular accident , pulmonary embolism and deep vein thrombosis . RESULTS After a follow-up of 2 years there was no statistically significant difference between the groups in progression-free time ; 65 of 217 ( 30 % ) patients in group 1 showed evidence of progression , including seven ( 3 % ) who died from prostate cancer . In group 2 , 64 of 227 ( 28 % ) patients showed progression and eight ( 3.5 % ) died from prostatic cancer . There were 10 ( 5 % ) cardiovascular complications in patients in group 1 , including five ( 2 % ) cardiovascular deaths ; in group 2 there were 24 ( 11 % ) and 14 ( 6 % ) , respectively . During the first year of treatment there were three ( 1.4 % ) cardiovascular complications in group 1 and 14 ( 6 % ) in group 2 ( P < 0.05 ) , and during the second year , seven ( 4 % ) and 10 ( 6 % ) , respectively . CONCLUSION Parenteral PEP ( 240 mg/month ) seems to be as efficient as orchidectomy in inhibiting disease in patients with advanced prostatic cancer ( T3 - 4 M0 and T1 - 4 M1 ) . There were more cardiovascular complications in patients treated with PEP than after orchidectomy ; the difference was statistically significant during the first year of treatment BACKGROUND The aim of the study was to evaluate overall and prostate cancer ( PCa ) specific survival with special attention to cardiovascular ( CV ) mortality in patients primarily treated by parenteral polyestradiol phosphate ( PEP ) 240 mg/month or with orchiectomy ( OE )  , taking into account the effect of pretreatment diseases and medication , and later PCa therapies . METHODS The present Finnprostate 6 study ( 10-year follow-up ) consisted of 244 patients with locally advanced PCa ( T3 - 4 M0 ) and 200 patients with metastatic PCa ( T1 - 4 M1 ) . Patients were r and omized to OE or PEP therapy .  The T3 - 4 M0 and T1 - 4 M1 patients were analyzed separately . RESULTS There was no difference in overall or PCa specific survival between the primary therapy groups in T3 - 4 M0 or T1 - 4 M1 patients . In the T3 - 4 M0 patients the primary treatment ( PEP vs. OE ) was statistically significantly associated with a risk of CV deaths ( P = 0.001 ) . Such an association was not found in the T1 - 4 M1 patients . CONCLUSIONS The primary PEP and OE therapies are equal in terms of overall and PCa specific survival in patients with T3 - 4 M0 or T1 - 4 M1 disease . In T3 - 4 M0 patients PEP increases the risk of CV deaths compared to OE but not in T1 - 4 M1 patients Thirty-eight patients with cancer of the prostate were treated with strict parenteral estrogen in the form of monthly polyestradiol phosphate injections--160 mg , 240 mg , and 320 mg -- in this nonr and omized study . In contrast to studies with oral estrogens , there have been no cardiovascular complications at a mean follow-up of 12.9 + /- 0.7 months ( SEM ) . Twenty-nine of the 38 patients ( 76 % ) have responded to therapy Objective To evaluate the cardiovascular ( CV ) complications associated with  orchiectomy ( OE )  and parenteral polyestradiol phosphate ( PEP ) therapy ( 240 mg/month ) , taking into account the effect of pretreatment diseases and pretreatment medication . Material and methods A total of 244 T3–4 M0 patients and 200 T1–4 M1 patients were r and omized to either OE or PEP therapy .  The two groups of patients were analyzed separately . The follow-up period was 36 months . The effect of pretreatment vascular and other diseases and pretreatment medication which may be associated with a risk of CV complications was evaluated . Results In the T3–4 M0 patients , the treatment ( PEP versus OE ) and the presence of pretreatment vascular diseases were statistically significantly associated with a risk of CV complications ( p=0.01 and 0.003 , respectively ) . In the T1–4 M1 patients , such an association was not found . No association was observed between pretreatment medication and CV complications . There was no difference in progression-free time between the therapy groups in either the T3–4 M0 or T1–4 M1 patients . Conclusion In patients with locally advanced prostatic cancer  , 
    Output:
    
The results provide no evidence to suggest that parenteral oestrogen  , in doses sufficient to produce castrate levels of testosterone , is less effective than luteinising hormone-releasing hormone ( LHRH ) or orchidectomy in controlling prostate cancer , or that it is consistently associated with an increase in cardiovascular mortality .