***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 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 . ) BACKGROUND No r and omized trials have compared survival outcomes for men with localized prostate cancer ( PC ) being treated with radical prostatectomy ( RP ) or external beam radiotherapy ( EBRT ) . The goal of the study , therefore , was to estimate the association of RP ( compared with EBRT ) with overall and PC mortality . METHODS We analyzed an observational cohort from the population -based Prostate Cancer Outcomes Study , which included men aged 55 to 74 years diagnosed with localized PC between October 1994 and October 1995 who underwent either RP ( n = 1164 ) or EBRT ( n = 491 ) within 1 year of diagnosis . Patients were followed until death or study end ( December 31 , 2010 ) . Overall and disease-specific mortality were assessed with multivariable survival analysis , with propensity scores to adjust for potential treatment selection confounders ( demographics , comorbidities , and tumor characteristics ) . All statistical tests were two-sided . RESULTS After 15 years of follow-up , there were 568 deaths , including 104 from PC . RP was associated with statistically significant advantages for overall ( hazard ratio [ HR ] = 0.60 , 95 % confidence interval [ CI ] = 0.53 to 0.70 , P < .0001 . ) and disease-specific mortality ( HR = 0.35 , 95 % CI = 0.26 to 0.49 , P < .0001 . ) . Mortality benefits for RP were also observed within treatment propensity quintiles , when subjects were pair-matched on propensity scores , and in subgroup analyses based on age , tumor characteristics , and comorbidity . CONCLUSIONS Population -based observational data on men diagnosed with localized PC in the mid-1990s suggest a mortality benefit associated with RP vs EBRT . Possible explanations include residual selection bias or a true survival advantage . Results might be less applicable for men facing treatment decisions today PURPOSE To report the primary endpoint of biochemical progression-free survival ( b-PFS ) and secondary survival endpoints from ASCENDE-RT , a r and omized trial comparing 2 methods of dose escalation for intermediate- and high-risk prostate cancer . METHODS AND MATERIAL S ASCENDE-RT enrolled 398 men , with a median age of 68 years ; 69 % ( n=276 ) had high-risk disease . After stratification by risk group , the subjects were r and omized to a st and ard arm with 12 months of and rogen deprivation therapy , pelvic irradiation to 46 Gy , followed by a dose-escalated external beam radiation therapy ( DE-EBRT ) boost to 78 Gy , or an experimental arm that substituted a low-dose-rate prostate brachytherapy ( LDR-PB ) boost . Of the 398 trial subjects , 200 were assigned to DE-EBRT boost and 198 to LDR-PB boost . The median follow-up was 6.5 years . RESULTS In an intent-to-treat analysis , men r and omized to DE-EBRT were twice as likely to experience biochemical failure ( multivariable analysis [ MVA ] hazard ratio [ HR ] 2.04 ; P=.004 ) . The 5- , 7- , and 9-year Kaplan-Meier b-PFS estimates were 89 % , 86 % , and 83 % for the LDR-PB boost versus 84 % , 75 % , and 62 % for the DE-EBRT boost ( log-rank P<.001 ) . The LDR-PB boost benefited both intermediate- and high-risk patients . Because the b-PFS curves for the treatment arms diverge sharply after 4 years , the relative advantage of the LDR-PB should increase with longer follow-up . On MVA , the only variables correlated with reduced overall survival were age ( MVA HR 1.06/y ; P=.004 ) and biochemical failure ( MVA HR 6.30 ; P<.001 ) . Although biochemical failure was associated with increased mortality and r and omization to DE-EBRT doubled the rate of biochemical failure , no significant overall survival difference was observed between the treatment arms ( MVA HR 1.13 ; P=.62 ) . CONCLUSIONS Compared with 78 Gy EBRT , men r and omized to the LDR-PB boost were twice as likely to be free of biochemical failure at a median follow-up of 6.5 years Purpose There are no r and omized trials to guide treatment decisions between radiotherapeutic and surgical options for patients with high-risk localized prostate cancer . Comparative studies have been limited by their ability to match patients on the basis of pretreatment prognostic variables and to adjust for the cancer-related , medical , and socioeconomic differences between patients who choose radiotherapeutic or surgical approaches . Methods We analyzed the outcome of all patients in the National Cancer Data base with high-risk , clinical ly localized prostate cancer with complete prognostic data who were treated with either radical prostatectomy ( RP ) , external beam radiotherapy ( EBRT ) combined with and rogen deprivation ( AD ) , or EBRT plus brachytherapy with or without AD .  Inverse probability of treatment weighting was used to adjust for covariable imbalance among treatment groups . The weighted time-dependent Cox proportional hazards model was then used to estimate the effects of treatment groups on survival , accounting for differential treatment initiation times . A predictive model of pathologic nodal ( pLN ) status was built using prostate-specific antigen level , Gleason score , and clinical T stage ; predicted pLN status was used to repeat the inverse probability of treatment weighting and time-dependent Cox proportional hazards model . Results A total of 42,765 patients were analyzed . There was no statistically significant difference in survival between RP and EBRT plus brachytherapy with or without AD ( hazard ratio [ HR ] , 1.17 ; 95 % CI , 0.88 to 1.55 ) . However , EBRT plus AD was associated with higher mortality than RP ( HR , 1.53 ; 95 % CI , 1.22 to 1.92 ) . Adjustment for predicted pLN status did not yield statistically different results . A sensitivity analysis showed that EBRT plus AD ≥ 7920 cGy narrowed the difference , but a significantly higher mortality remained ( HR , 1.33 ; 95 % CI , 1.05 to 1.68 ) . Conclusion After comprehensively adjusting for imbalances in prostate cancer prognostic factors , other medical conditions , and socioeconomic factors , this analysis showed no statistical difference in survival between patients treated with RP versus EBRT plus brachytherapy with or without AD . EBRT plus AD was associated with lower survival Since there was no consensus on treatment options of localized prostate cancer , a meta- analysis was performed to compare the efficacy of radical prostatectomy ( RP ) versus external beam radiotherapy ( EBRT ) concluding three-dimensional conformal radiotherapy ( 3DCRT ) and intensity-modulated radiation therapy ( IMRT ) . The search of eligible studies was performed on PubMed and Embase data bases . The overall survival ( OS ) , cancer-specific survival ( CSS ) and biochemical disease-free survival ( BDFS ) were compared by hazard ratio ( HR ) and odd ratios ( OR ) . Twelve studies with 17137 patients were included . The pooled HR and 95 % CI for OS , CSS and BDFS were 1.60 ( 1.44–1.79 ) , 1.73 ( 1.34–2.24 ) and 0.65 ( 0.51–0.82 ) , respectively . However , according to risk stratification , the HRs of CSS for low- to intermediate-risk patients were not significant . The 5-year and 10-year CSS reported significant OR and 95 % CI of 1.96 ( 1.42–2.72 ) and 2.44 ( 1.33–4.48 ) , except for 2-year CSS ( P = 0.42 ) . In conclusion , RP was generally associated with decreased risk of overall and cancer-specific mortality as well as better 5-year and 10-year OS and CSS . The EBRT was suggested to be a promising alternative option for low- to intermediate-risk patients . Large-scale prospect i ve studies with risk stratification and adequate follow-up length were needed for further comprehensive comparison BACKGROUND Patterns of postoperative radiotherapy ( RT ) use in prostate cancer ( PCa ) after the publication of major r and omized trials have not been well characterized . OBJECTIVE To describe patterns of postoperative RT use after radical prostatectomy ( RP ) in patients with adverse pathologic features in the United States . DESIGN , SETTING , AND PARTICIPANTS Retrospective analysis of 97 270 patients with PCa diagnosed between 2005 and 2011 whose presentation and outcomes were recorded in the National Cancer Data Base . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Temporal changes in receipt of postoperative RT  and factors associated with receipt of this treatment using the Cochran-Armitage trend test and multiple logistic regression , respectively . RESULTS AND LIMITATIONS Between 2005 and 2011 , receipt of postoperative RT  decreased steadily from 9.1 % to 7.3 % ( ptrend<0.001 ) . Use of RT with or without and rogen deprivation therapy  monotonically decreased with advancing age from 8.5 % in patients aged 18 - 59 yr to 6.8 % in patients aged 70 - 79 yr ( ptrend<0.001 ) . Receipt of RT  was higher at community cancer programs compared with teaching/ research centers ( 14 % vs 7.3 % ; odds ratio [ OR ] : 2.16 ; p<0.001 ) , in those with pT3 - 4 disease and positive margins compared with those with pT3 - 4 and negative margins ( 17 % vs 5.9 % ; OR : 2.89 ; p<0.001 ) , and in patients with a Gleason score of 8 - 10 compared with those with a 
    Output:
    
Evidence demonstrating definitive superiority of either modality is lacking .
Recent studies show improved consideration of ADT , radiation dose , brachytherapy boost , and utilization of postoperative adjuvant radiation .
More recent studies with current st and ard of care radiation regimens using and rogen deprivation therapy or brachytherapy boost demonstrate approaching equivalence of prostatectomy and radiation modalities .