***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: 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 BACKGROUND The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen ( PSA ) testing remains uncertain . METHODS We compared active monitoring , radical prostatectomy , and external-beam radiotherapy for the treatment of clinical ly localized prostate cancer . Between 1999 and 2009 , a total of 82,429 men 50 to 69 years of age received a PSA test ; 2664 received a diagnosis of localized prostate cancer , and 1643 agreed to undergo r and omization to active monitoring ( 545 men ) , surgery ( 553 ) , or radiotherapy ( 545 ) . The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up . Secondary outcomes included the rates of disease progression , metastases , and all-cause deaths . RESULTS There were 17 prostate-cancer-specific deaths overall : 8 in the active-monitoring group ( 1.5 deaths per 1000 person-years ; 95 % confidence interval [ CI ] , 0.7 to 3.0 ) , 5 in the surgery group ( 0.9 per 1000 person-years ; 95 % CI , 0.4 to 2.2 ) , and 4 in the radiotherapy group ( 0.7 per 1000 person-years ; 95 % CI , 0.3 to 2.0 ) ; the difference among the groups was not significant ( P=0.48 for the overall comparison ) . In addition , no significant difference was seen among the groups in the number of deaths from any cause ( 169 deaths overall ; P=0.87 for the comparison among the three groups ) . Metastases developed in more men in the active-monitoring group ( 33 men ; 6.3 events per 1000 person-years ; 95 % CI , 4.5 to 8.8 ) than in the surgery group ( 13 men ; 2.4 per 1000 person-years ; 95 % CI , 1.4 to 4.2 ) or the radiotherapy group ( 16 men ; 3.0 per 1000 person-years ; 95 % CI , 1.9 to 4.9 ) ( P=0.004 for the overall comparison ) . Higher rates of disease progression were seen in the active-monitoring group ( 112 men ; 22.9 events per 1000 person-years ; 95 % CI , 19.0 to 27.5 ) than in the surgery group ( 46 men ; 8.9 events per 1000 person-years ; 95 % CI , 6.7 to 11.9 ) or the radiotherapy group ( 46 men ; 9.0 events per 1000 person-years ; 95 % CI , 6.7 to 12.0 ) ( P<0.001 for the overall comparison ) . CONCLUSIONS At a median of 10 years , prostate-cancer-specific mortality was low irrespective of the treatment assigned , with no significant difference among treatments . Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring . ( Funded by the National Institute for Health Research ; ProtecT Current Controlled Trials number , IS RCT N20141297 ; Clinical Trials.gov number , NCT02044172 . ) Prostate intervention versus observation trial ( PIVOT ) is the largest and longest r and omized trial conducted in men with early stage prostate cancer detected during the era of wide-spread prostate-specific antigen ( PSA ) testing.1 PIVOT enrolled 731 men and followed them for up to 15 years after r and omization . PIVOT results demonstrate that compared to observation , radical prostatectomy did not result in a significant reduction in all cause or prostate cancer mortality through at least 12 years among men with localized prostate cancer ; absolute differences were less than 3 % . Results changed little after 8 years ; therefore , additional follow-up is unlikely to change our findings . Radical prostatectomy caused related harms within 30 days of surgery in 21 % of men and urinary incontinence and erectile dysfunction through at least 2 years . Prostate cancer mortality was infrequent among all men treated with observation ( approximately 8 % ) and rare ( 3 % ) in men with PSA values of 10 or less or those with low-risk disease , which is important and reassuring findings for men , their families and physicians . Noncancer death rates and surgical quality in PIVOT were similar to other studies enrolling men with early stage prostate cancer . The mean age of 67 years , health status and comorbidities were similar to most men diagnosed with prostate cancer and to other trials . The effect of radical prostatectomy did not vary by patient age , race , health status or presence of other medical conditions . In men with low PSA ( ≤10 ) or low-risk disease death from prostate cancer is rare in men treated with observation and surgery had no reduction in overall or prostate cancer mortality or risk of bone metastases . Surgery may reduce mortality and bone metastases in men with higher PSA or higher-risk disease . However , subgroup findings should be viewed with caution . Any positive results were based on multiple subgroups assessed , rarely met traditional levels of statistical significance , often were sensitive to methods of analysis and may be due to chance . Three-quarters of men with early stage prostate cancer have low PSA or low-risk disease . Men diagnosed today and managed with observation likely have even a better prognosis than men enrolled in PIVOT because of detection of smaller more indolent disease . PIVOT results , combined with other data from r and omized treatment and screening trials , indicate that observation should be the preferred treatment strategy for the majority of men currently diagnosed with early stage prostate cancer . Such a strategy can help men live a similar length of life , avoid death from prostate cancer and prevent treatment related harms and costs . In conclusion , PIVOT demonstrated that surgery did not reduce overall or cancer mortality compared to observation through at least 12 years ' absolute differences were less than 3 % . While surgery may reduce mortality in the minority of men with PSA greater than 10 or with high-risk disease , it did not improve outcomes in men with PSA of 10 or less or with low-risk disease . Observation should be recommended as the preferred treatment option ; it results in similar length of life prevention of prostate cancer death and avoids surgical harms . R and omized controlled trials are needed to evaluate new , more effective and safer screening and treatment approaches for men with aggressive prostate cancer Abstract Context To treat or not to treat is one of the most difficult dilemmas facing prostate cancer patients , especially elderly men with early prostate cancer or small cancer that is contained within the prostate . Objective The primary objective of this review is to analyse the treatment options for patients with localised prostate cancer . This information can be considered alongside other important factors like natural history of disease and diagnostic tests . Evidence acquisition Several r and omised and nonr and omised clinical trials published in the literature investigating the natural history of the disease , diagnostic tests , and treatment options for localised prostate cancer have been review ed for this paper . Evidence synthesis Analysis of prostate-specific antigen ( PSA ) kinetics should play a major role in the management of localised prostate cancer . Trials investigating long-term outcomes of active surveillance are under way . Conclusion Taking all these factors into consideration , the data support active surveillance as an appropriate choice for patients with well-differentiated or moderately differentiated , low-volume prostate cancer who have a life expectancy To present the baseline patient‐reported outcome measures ( PROMs ) in the Prostate Testing for Cancer and Treatment ( ProtecT ) r and omized trial comparing active monitoring , radical prostatectomy and external‐beam conformal radiotherapy for localized prostate cancer and to compare results with other population Importance Prostate cancer screening remains controversial because potential mortality or quality -of-life benefits may be outweighed by harms from overdetection and overtreatment . Objective To evaluate the effect of a single prostate-specific antigen ( PSA ) screening intervention and st and ardized diagnostic pathway on prostate cancer – specific mortality . Design , Setting , and Participants The Cluster R and omized Trial of PSA Testing for Prostate Cancer ( CAP ) included 419 582 men aged 50 to 69 years and was conducted at 573 primary care practice s across the United Kingdom . R and omization and recruitment of the practice s occurred between 2001 and 2009 ; patient follow-up ended on March 31 , 2016 . Intervention An invitation to attend a PSA testing clinic and receive a single PSA test vs st and ard ( unscreened ) practice . Main Outcomes and Measures Primary outcome : prostate cancer – specific mortality at a median follow-up of 10 years . Prespecified secondary outcomes : diagnostic cancer stage and Gleason grade ( range , 2 - 10 ; higher scores indicate a poorer prognosis ) of prostate cancers identified , all-cause mortality , and an instrumental variable analysis estimating the causal effect of attending the PSA screening clinic . Results Among 415 357 r and omized men ( mean [ SD ] age , 59.0 [ 5.6 ] years ) , 189 386 in the intervention group and 219 439 in the control group were included in the analysis ( n = 408 825 ; 98 % ) . In the intervention group , 75 707 ( 40 % ) attended the PSA testing clinic and 67 313 ( 36 % ) underwent PSA testing . Of 64 436 with a valid PSA test result , 6857 ( 11 % ) had a PSA level between 3 ng/mL and 19.9 ng/mL , of whom 5850 ( 85 % ) had a prostate biopsy . After a median follow-up of 10 years , 549 ( 0.30 per 1000 person-years ) died of prostate cancer in the intervention group vs 647 ( 0.31 per 1000 person-years ) in the control group ( rate difference , −0.013 per 1000 person-years [ 95 % CI , −0.047 to 0.022 ] ; rate ratio [ RR ] , 0.96 [ 95 % CI , 0.85 to 1.08 ] ; P = .50 ) . The number diagnosed with prostate cancer was higher in the intervention group ( n = 8054 ; 4.3 % ) than in the control group ( n = 7853 ; 3.6 % ) ( RR , 1.19 [ 95 % CI , 1.14 to 1.25 ] ; P < .001 ) . More prostate cancer tumors with a Gleason grade of 6 or lower were identified in the intervention group ( n = 3263/189 386 [ 1.7 % ] ) than in the control group ( n = 2440/219 439 [ 1.1 % ] ) ( difference per 1000 men , 6.11 [ 95 % CI , 5.38 to 6.84 ] ; P < .001 ) . In the analysis of all-cause mortality , there were 25 459 deaths in the intervention group vs 28 306 deaths in the control group ( RR , 0.99 [ 95 % CI , 0.94 to 1.03 ] ; P = .49 ) . In the instrumental variable analysis for prostate cancer mortality , the adherence-adjusted causal RR was 0.93 ( 95 % CI , 0.67 to 1.29 ; P = .66 ) . Conclusions and Relevance Among practice s r and omized to a single PSA screening intervention vs st and ard practice without 
    Output:
    
Based on long-term follow-up , RP compared with WW probably results in substantially improved oncological outcomes in men with localised prostate cancer but also markedly increases rates of urinary incontinence and erectile dysfunction .
Compared to AM , based on follow-up to 10 years , RP probably has similar outcomes with regard to overall and disease-specific survival yet probably reduces the risks of disease progression and metastatic disease .
Urinary function and sexual function are probably decreased for the patients treated with RP