***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: OBJECTIVE Focal therapy is an emerging approach to the treatment of localized prostate cancer . The purpose of this study was to report the 6-month follow-up oncologic and functional data of the initial phase 1 trial of patients treated with focal transrectal MRI-guided focused ultrasound in North America . SUBJECTS AND METHODS Four patients with a prostate-specific antigen ( PSA ) level of 10 ng/mL or less , tumor classification cT2a or less , and a Gleason score of 6 ( 3 + 3 ) were prospect ively enrolled in the study and underwent  multiparametric MRI and transrectal ultrasound-guided prostate systematic biopsy . Under MRI guidance and real-time monitoring with MR thermography , focused high-frequency ultrasound energy was delivered to ablate the target tissue . The incidence and severity of treatment-related adverse events were recorded along with responses to serial quality -of-life question naires for 6 months after treatment . Oncologic outcomes were evaluated with multiparametric MRI and repeat transrectal ultrasound-guided biopsy 6 months after treatment . RESULTS Four patients with a total of six target lesions were treated and had complications grade d Clavien-Dindo I or less . Quality -of-life parameters were similar between baseline and 6-months . All four patients had normal MRI findings in the treated regions ( 100 % ) , biopsy showed that three patients ( 75 % ) were clear of disease in the treated regions , representing complete ablation of five target lesions ( 83 % ) . All patients had at least one Gleason 6-positive core outside of the treated zone . CONCLUSION MRI-guided focused ultrasound is a feasible method of noninvasively ablating low-risk prostate cancers with low morbidity . Further investigation and follow-up are warranted in a larger patient series with appropriate statistical analysis of oncologic and functional outcome measures BACKGROUND Tissue preservation by means of focal therapy offers some men with clinical ly significant prostate cancer an alternative to st and ard care that appears to confer favourable genito-urinary outcomes . The precise estimates of these outcomes have so far been based on small series . OBJECTIVE This analysis pools the sexual domain related patient reported outcomes from three prospect i ve , registered studies that represent a range of inclusion criteria . DESIGN , SETTING , AND PARTICIPANTS One-hundred and eighteen men with localised prostate cancer ( prostate specific antigen ≤ 15ng/ml , Gleason ≤ 4 + 3 , stage ≤ T3aN0M0 ) treated in a tissue-preserving manner using high intensity focused ultrasound from three registered studies were included . Data on International Index of Erectile Function ( IIEF-5 ) scores and use of phosphodiesterase-5-inhibitors were collected at baseline , and 1 mo , 3 mo , 6 mo , 9 mo , and 12 mo postoperatively . The IIEF-15 total and individual domain scores were used to assess overall sexual function . Urinary function was assessed with the International Prostate Symptom Score ( IPSS ) , IPSS quality -of-life , and UCLA-Exp and ed Prostate Cancer Index Composite continence question naires . General health status was derived by means of the Charlson score . Multiple linear regression was used to assess whether age , grade , stage , qualitative scores ( IIEF , IPSS , Exp and ed Prostate Cancer Index Composite , Charlson ) , or focal therapy type duration were associated with IIEF-5 and IIEF-15 scores at 12 mo . RESULTS AND LIMITATIONS Median age was 63 yr ( interquartile range [ IQR ] 52 - 70 yr ) . Median IIEF-erectile score at baseline was 23 ( IQR 11 - 28 ) . This declined significantly to 9 ( IQR 3 - 22 , p<0.01 ) at 1 mo , but improved to 20 ( IQR 9 - 29 , p=0.30 ) at 1 yr posttreatment . Changes in total IIEF and other IIEF domains were only significantly different from preoperative values at 1 mo and 3 mo postoperatively . In the same period , the proportion of men using phosphodiesterase-5-inhibitors was 10 % preoperatively , reaching 43 % and 42 % at 6 mo and 9 months before declining to 37 % at 1 yr . The only baseline determinants of postoperative erectile function were total IIEF and IIEF-erectile function scores ( p=0.002 ) . The primary limitation of our study is the relatively short follow-up of 1 yr . CONCLUSION Men who received a range of tissue preserving therapies from the three pertinent studies experienced small decreases in total IIEF , erectile , and individual sexual domain scores that are not significantly different to those recorded at baseline . The only determinant of erectile dysfunction after tissue preserving therapy was preoperative erectile dysfunction status . Tissue preservation confers a high probability of maintaining erectile function that appears independent of all perioperative factors with the exception of baseline status . PATIENT SUMMARY In this report , the largest prospect ively collected and published set of patients with erectile dysfunction  outcomes post-focal therapy for prostate cancer , we have found a return to baseline International Index of Erectile Function-erectile and total International Index of Erectile Function scores by 6 mo post-focal therapy which was maintained at 1 yr , with the majority of patients not on any form of medical treatment for their erectile dysfunction at that point . Focal therapy may represent a suitable alternative for men of any age or comorbidity wishing to maintain erectile function BACKGROUND High-intensity focused ultrasound ( HIFU ) is a nonsurgical therapy for selected patients with localized prostate cancer ( PCa ) . OBJECTIVE The long-term oncologic and morbidity outcomes of primary HIFU therapy for localized PCa were evaluated in a prospect i ve , single-arm , single-institution cohort study . DESIGN , SETTING , AND PARTICIPANTS Participants were patients treated with HIFU for localized PCa from 1997 to 2009 . Excluded were patients with local recurrence following radiotherapy .  A second HIFU session was systematic ally performed in patients with biopsy-proven local recurrence . INTERVENTION Whole-gl and prostate ablation with transrectal HIFU . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Incontinence was assessed using the Ingelman-Sundberg score , and potency was assessed using the five-item version of the International Index of Erectile Function ( IIEF-5 ) scores . Primary outcomes were survival rates ( biochemical-free , cancer-specific , metastasis-free , and overall survival ) . Secondary outcomes were morbidity rates . Median follow-up was 6.4 yr ( range : 0.2 - 13.9 ) . The Kaplan-Meier method was used to determine survival estimates , and multivariate analysis was used to determine predictive factors of biochemical progression . RESULTS AND LIMITATIONS A total of 1002 patients were included . The median nadir prostate-specific antigen ( PSA ) was 0.14 ng/ml , with 63 % of patients reaching a nadir PSA ≤0.3 ng/ml . Sixty percent of patients received one HIFU session , 38 % received two sessions , and 2 % received three sessions . The 8-yr biochemical-free survival rates ( Phoenix definition ) were 76 % , 63 % , and 57 % for low- , intermediate- , and high-risk patients , respectively ( p < 0.001 ) . At 10 yr , the PCa-specific survival rate and metastasis-free survival rate ( MFSR ) were 97 % and 94 % , respectively . Salvage therapies included external-beam radiation therapy ( EBRT ) ( 13.8 % ) , EBRT plus and rogen-deprivation therapy ( ADT ) ( 9.7 % ) , and ADT alone ( 12.1 % ) . Severe incontinence and bladder outlet obstruction decreased with refinement in the technology , from 6.4 % and 34.9 % to 3.1 % and 5.9 % , respectively . Limitations included the fact that the study was a single-arm study without a comparison group , technological improvements , changes in surgical protocol during the study , and the use of ADT to downsize the prostate in 39 % of patients . CONCLUSIONS HIFU is a potentially effective treatment of localized PCa , with a low PCa-specific mortality rate and a high MFSR at 10 yr as well as acceptable morbidity BACKGROUND In selected patients with unilateral , organ-confined prostate cancer ( PCa ) , hemiablation of the affected lobe might be feasible to achieve acceptable cancer control with fewer complications . OBJECTIVES To assess the oncologic and functional outcomes of focal high-intensity focused ultrasound ( HIFU ) hemiablation in unilateral organ-confined PCa . DESIGN , SETTING AND PATIENTS Single-center prospect i ve evaluation of HIFU hemiablation for unilateral organ-confined PCa was performed from July 2009 through December 2013 . INTERVENTION Cancer localization was done with transrectal ultrasound-guided biopsy and multiparametric magnetic resonance imaging followed by HIFU hemiablation . OUTCOME MEASUREMENT AND STATISTICAL ANALYSIS Oncologic outcomes were analyzed with control biopsies and prostate-specific antigen ( PSA ) measurement . Functional outcomes were assessed with vali date d question naires for genitourinary symptoms . RESULTS AND LIMITATIONS Of 71 HIFU hemiablation patients , 67 completed the study protocol . The mean age was 70.2 yr ( st and ard deviation : 6.8 yr ) , and median PSA was 6.1 ng/ml ( interquartile range [ IQR ] : 1.6 - 15.5 ng/ml ) . Median maximum cancer-core length was 3 mm ( IQR : 2 - 10 mm ) , and total cancer length was 6.5 mm ( IQR : 2 - 24 mm ) . Gleason score was 6 ( 3 + 3 ) in 58 patients ( 86.6 % ) and 7 ( 3 + 4 ) in 9 patients ( 13.4 % ) . Median follow-up was 12 mo ( IQR : 6 - 50 mo ) , and at 12 mo , 56 of 67 patients had a negative control biopsy in the treated lobe . At 3 mo , all patients were continent , and potency was maintained in 11 of 21 preoperatively potent patients ( confidence interval , 0.18 - 0.69 ) . Complications included 8 % Clavien-Dindo grade 2 and 2.8 % grade 3 events . CONCLUSIONS Focal HIFU hemiablation appears to achieve acceptable oncologic outcomes with low morbidity and minimal functional changes . Longer follow-up will establish future considerations . PATIENT SUMMARY This study showed that high-intensity focused ultrasound hemiablation in selected patients with unilateral organ-confined prostate cancer can be used for satisfactory cancer control with minimal effect on genitourinary functions PURPOSE Multiparametric magnetic resonance imaging and magnetic resonance imaging targeted biopsy may improve the detection of clinical ly significant prostate cancer . However , st and ardized prospect i ve evaluation is limited . MATERIAL S AND METHODS A total of 294 consecutive men with suspicion of prostate cancer ( 186 primary , 108 repeat biopsies ) enrolled in 2013 underwent 3 T multiparametric magnetic resonance imaging ( T2-weighted , diffusion weighted , dynamic contrast enhanced ) without endorectal coil and systematic transperineal cores ( median 24 ) independently of magnetic resonance imaging suspicion and magnetic resonance imaging targeted cores with software registration ( median 4 ) . The highest Gleason score from each biopsy method was compared . McNemar 's tests were used to evaluate detection rates . Predictors of Gleason score 7 or greater disease were assessed using logistic regression . RESULTS Overall 150 cancers and 86 Gleason score 7 or greater cancers were diagnosed .  Systematic , transperineal biopsy missed 18 Gleason score 7 or greater tumors ( 20.9 % ) while targeted biopsy did not detect 11 ( 12.8 % ) . Targeted biopsy of PI-RADS 2 - 5 alone overlooked 43.8 % of Gleason score 6 tumors . McNemar 's tests for detection of Gleason score 7 or greater cancers in both modalities were not statistically significant but showed a trend of superiority for targeted primary biopsies ( p=0.08 ) . Sampling efficiency was in favor of magnetic resonance imaging targeted prostate biopsy with 46.0 % of targeted biopsy vs 7.5 % of systematic , transperineal biopsy cores detecting Gleason score 7 or greater cancers . To diagnose 1 Gleason score 7 or greater cancer , 3.4 targeted and 7.4 systematic biopsies were needed . Limiting biopsy to men with PI-RADS 3 - 5 would have missed 17 Gleason score 7 or greater tumors ( 19.8 % ) , demonstrating limited magnetic resonance imaging sensitivity . PI-RADS scores , digital rectal examination findings and prostate specific antigen greater than 20 ng/ml were predictors of Gleason score 7 or greater disease . CONCLUSIONS Compared to systematic , transperineal biopsy as a reference test , magnetic resonance imaging targeted biopsy alone detected as many Gleason score 7 
    Output:
    
Conclusions : Early evidence suggests that partial gl and ablation is a safe treatment option for men with localized disease .