***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: 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 Summary Background Patient-reported outcomes ( PROs ) might detect more toxic effects of radiotherapy than do clinician-reported outcomes . We did a quality of life ( QoL ) sub study to assess PROs up to 24 months after conventionally fractionated or hypofractionated radiotherapy in the Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer ( CHHiP ) trial . Methods The CHHiP trial is a r and omised , non-inferiority phase 3 trial done in 71 centres , of which 57 UK hospitals took part in the QoL sub study . Men with localised prostate cancer who were undergoing radiotherapy were eligible for trial entry if they had histologically confirmed T1b – T3aN0M0 prostate cancer , an estimated risk of seminal vesicle involvement less than 30 % , prostate-specific antigen concentration less than 30 ng/mL , and a WHO performance status of 0 or 1 . Participants were r and omly assigned ( 1:1:1 ) to receive a st and ard fractionation schedule of 74 Gy in 37 fractions or one of two hypofractionated schedules : 60 Gy in 20 fractions or 57 Gy in 19 fractions . R and omisation was done with computer-generated permuted block sizes of six and nine , stratified by centre and National Comprehensive Cancer Network ( NCCN ) risk group . Treatment allocation was not masked . UCLA Prostate Cancer Index ( UCLA-PCI ) , including Short Form (SF)-36 and Functional Assessment of Cancer Therapy-Prostate ( FACT-P ) , or Exp and ed Prostate Cancer Index Composite ( EPIC ) and SF-12 quality -of-life question naires were completed at baseline , pre-radiotherapy , 10 weeks post-radiotherapy , and 6 , 12 , 18 , and 24 months post-radiotherapy . The CHHiP trial completed accrual on June 16 , 2011 , and the QoL sub study was closed to further recruitment on Nov 1 , 2009 . Analysis was on an intention-to-treat basis . The primary endpoint of the QoL sub study was overall bowel bother and comparisons between fractionation groups were done at 24 months post-radiotherapy . The CHHiP trial is registered with IS RCT N registry , number IS RCT N97182923 . Findings 2100 participants in the CHHiP trial consented to be included in the QoL sub study : 696 assigned to the 74 Gy schedule , 698 assigned to the 60 Gy schedule , and 706 assigned to the 57 Gy schedule . Of these individuals , 1659 ( 79 % ) provided data pre-radiotherapy and 1444 ( 69 % ) provided data at 24 months after radiotherapy . Median follow-up was 50·0 months ( IQR 38·4–64·2 ) on April 9 , 2014 , which was the most recent follow-up measurement of all data collected before the QoL data were analysed in September , 2014 . Comparison of 74 Gy in 37 fractions , 60 Gy in 20 fractions , and 57 Gy in 19 fractions groups at 2 years showed no overall bowel bother in 269 ( 66 % ) , 266 ( 65 % ) , and 282 ( 65 % ) men ; very small bother in 92 ( 22 % ) , 91 ( 22 % ) , and 93 ( 21 % ) men ; small bother in 26 ( 6 % ) , 28 ( 7 % ) , and 38 ( 9 % ) men ; moderate bother in 19 ( 5 % ) , 23 ( 6 % ) , and 21 ( 5 % ) men , and severe bother in four ( < 1 % ) , three ( < 1 % ) and three ( < 1 % ) men respectively ( 74 Gy vs 60 Gy , ptrend=0.64 , 74 Gy vs 57 Gy , ptrend=0·59 ) . We saw no differences between treatment groups in change of bowel bother score from baseline or pre-radiotherapy to 24 months . Interpretation The incidence of patient-reported bowel symptoms was low and similar between patients in the 74 Gy control group and the hypofractionated groups up to 24 months after radiotherapy . If efficacy outcomes from CHHiP show non-inferiority for hypofractionated treatments , these findings will add to the growing evidence for moderately hypofractionated radiotherapy schedules becoming the st and ard treatment for localised prostate cancer . Funding Cancer Research UK , Department of Health , and the National Institute for Health Research Cancer Research Network 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 This study prospect ively evaluated quality of life ( QOL ) in localized prostate cancer patients undergoing radiotherapy  , and it examined the relationships between QOL , depression , fatigue , and sleep disturbance . Instruments that were used are Functional Assessment of Cancer Therapy for Prostate ( FACT-P ) , Beck Depression Inventory ( BDI ) , Piper Fatigue Scale ( PFS ) , and Epworth Sleepiness Scale ( ESS ) . We evaluated patients at preradiotherapy ( PRT ) , midway radiotherapy ( MRT ) , completion of radiotherapy ( CRT ) , follow-up radiotherapy ( 4 to 8 wk ) ( FRT ) , and long-term follow-up radiotherapy ( FRT2 ) ( 12 mo or more ) . Forty participants with a mean age of 67.8 yr were studied . Duration of radiotherapy was 7 - 8 wk . Mean long-term follow-up period post-CRT was 16.2 mo ( range 12- 24 mo ) . All patients had clinical T1c to T2b prostate cancer .  Prostate Cancer Specific ( PCS ) and Physical Well-Being ( PWB ) subscales of FACT-P , scores at MRT and CRT were significantly lower than at PRT . At FRT2 , PWB scores declined further , while PCS scores increased . PFS median scores were significantly higher at CRT and at FRT2 as compared with PRT . Patients scoring higher on PFS were more likely to report a poorer QOL and PWB as measured with FACT-P question naire . No significant changes were noted in the BDI and ESS scores during the study periods . The PWB declined during and at CRT and worsened at FRT2 . Decline in PCS subscale scores during and at CRT reflects worsening of urinary symptoms and appearance of bowel problems . The scores improved at long-term follow-up . A relationship was found to exist between physical well-being and fatigue BACKGROUND The proportion of younger men ( < 65 years ) diagnosed with prostate cancer ( PCa ) has increased significantly . We sought to analyze the association between race/ethnicity , biochemical recurrence risk and outcomes in younger men with PCa . METHODS In this prospect i ve cohort study , we recruited 318 younger men with newly diagnosed PCa . Participants completed generic and prostate-specific Health Related Quality of Life ( HRQoL ) , out-of-pocket cost and satisfaction with care surveys at baseline and at 3 , 6 , 12 , and 24 months of follow-up . Health re source utilization and cost data were obtained from the hospital based administrative data bases . We compared time to return to baseline ( RTB ) of HRQoL scores across groups . Survival curves were used to compare mean time to RTB across groups . Linear mixed effects ( LMEs ) and generalized linear ( GLM ) models were used to analyze the association of race/ethnicity and biochemical recurrence groups with outcomes . RESULTS African Americans reported lower generic and prostate 
    Output:
    
These patterns persisted up to the 5th year .
High-intensity focused ultrasound and active surveillance only have results at 1st year , showing no statistically significant worsening .
No remarkable differences in PRO appeared between modalities within each treatment .