***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: BACKGROUND It is not known whether short-term and rogen-deprivation therapy ( ADT ) before and during radiotherapy improves cancer control and overall survival among patients with early , localized prostate adenocarcinoma . METHODS From 1994 through 2001 , we r and omly assigned 1979 eligible patients with stage T1b , T1c , T2a , or T2b prostate adenocarcinoma and a prostate-specific antigen ( PSA ) level of 20 ng per milliliter or less to radiotherapy alone ( 992 patients ) or radiotherapy with 4 months of total and rogen suppression starting 2 months before radiotherapy ( radiotherapy plus short-term ADT , 987 patients ) . The primary end point was overall survival . Secondary end points included disease-specific mortality , distant metastases , biochemical failure ( an increasing level of PSA ) , and the rate of positive findings on repeat prostate biopsy at 2 years . RESULTS The median follow-up period was 9.1 years . The 10-year rate of overall survival was 62 % among patients receiving radiotherapy plus short-term ADT ( the combined-therapy group ) , as compared with 57 % among patients receiving radiotherapy alone ( hazard ratio for death with radiotherapy alone , 1.17 ; P=0.03 ) . The addition of short-term ADT was associated with a decrease in the 10-year disease-specific mortality from 8 % to 4 % ( hazard ratio for radiotherapy alone , 1.87 ; P=0.001 ) . Biochemical failure , distant metastases , and the rate of positive findings on repeat prostate biopsy at 2 years were significantly improved with radiotherapy plus short-term ADT . Acute and late radiation-induced toxic effects were similar in the two groups . The incidence of grade 3 or higher hormone-related toxic effects was less than 5 % . Re analysis according to risk showed reductions in overall and disease-specific mortality primarily among intermediate-risk patients , with no significant reductions among low-risk patients . CONCLUSIONS Among patients with stage T1b , T1c , T2a , or T2b prostate adenocarcinoma and a PSA level of 20 ng per milliliter or less , the use of short-term ADT for 4 months before and during radiotherapy was associated with significantly decreased disease-specific mortality and increased overall survival . According to post hoc risk analysis , the benefit was mainly seen in intermediate-risk , but not low-risk , men . ( Funded by the National Cancer Institute ; RTOG 94 - 08 Clinical Trials.gov number , NCT00002597 . ) Purpose : Castration therapy adjuvant to radiotherapy can significantly improve overall survival compared with radiotherapy alone in patients with locally advanced prostate cancer . Although many of the adverse effects of castration therapy are manageable , they can have a detrimental effect on quality of life . Here we evaluate the efficacy and tolerability of the non-castration-based therapy bicalutamide ( ‘ Casodex ’ ) 150 mg adjuvant to radiotherapy in patients with T1 - 4 , M0 , any n prostate cancer . Methods : The subset of patients within the early prostate cancer ( EPC ) program who received radiotherapy with curative intent ( n = 1,370 ) were included in the analysis . These patients were r and omized to receive oral bicalutamide 150 mg once daily ( n = 699 ) or placebo ( n = 671 ) . Results : The median follow-up for patients included in this analysis was 7.2 years . In patients with locally advanced disease ( n = 305 )  , bicalutamide adjuvant to radiotherapy significantly improved : progression-free survival ( PFS ) , reducing the risk of objective progression by 44 % compared with radiotherapy alone [ hazard ratio ( HR ) 0.56 ; 95 % confidence interval ( CI ) 0.40 , 0.78 ; P < 0.001 ) . Prostate-specific antigen (PSA)–PFS , reducing the risk of PSA progression by 59 % compared with radiotherapy alone ( HR 0.41 ; 95 % CI 0.30 , 0.55 ; P < 0.001 ) . Overall survival , reducing the risk of death by 35 % compared with radiotherapy alone ( HR 0.65 ; 95 % CI 0.44 , 0.95 ; P = 0.03 ) . This significant overall survival benefit for bicalutamide was driven by a lower risk of prostate cancer-related deaths ( 16.1 vs 24.3 % , respectively ) . There was no significant difference in PFS or overall survival in patients with localized disease ( n = 1,065 ) . Conclusions : In patients with locally advanced disease  , bicalutamide 150 mg adjuvant to radiotherapy demonstrates significant clinical benefits in terms of overall survival , PFS and PSA – PFS compared with radiotherapy alone . The overall survival benefit in these patients is consistent with prior studies evaluating castration-based therapies adjuvant to radiotherapy ( Bolla et al. in Lancet 360:103–108 , 2002 ; Pilepich et al. in Int J Radiat Oncol Biol Phys 61:1285–1290 , 2005 ) . In addition , the clinical benefit of bicalutamide 150 mg in locally advanced patients , but not in those with localized disease , is consistent with the overall results from the EPC program ( McLeod et al. BJU Int 97:247–254 , 2006 ) . Given the quality -of-life advantages of bicalutamide relative to castration , bicalutamide 150 mg adjuvant to radiotherapy is an attractive alternative for men with locally advanced prostate cancer PURPOSE We evaluated the benefits and sequencing of and rogen suppression ( AS ) administered with external beam radiation therapy ( EBRT ) in T2-T3 prostate cancers . MATERIAL S AND METHODS Between 1990 and 1999 , 481 patients were entered in 2 successive , prospect i ve , r and omized studies , including 161 in the study 1 and 325 in study 2 . Eligible patients had clinical stages T2-T3 prostate cancer . In the first study ( L-101 ) subjects were r and omly allocated among EBRT alone ( group 1 ) , EBRT preceded by 3 months of AS ( group 2 ) , and neoadjuvant , concomitant and adjuvant AS for a total of 10 months ( group 3 ) . In the second study ( L-200 ) we analyzed neoadjuvant and concomitant AS ( total 5 months ) vs neoadjuvant , concomitant and short course adjuvant ( total 10 months ) AS with EBRT . In each study we used a total AS ( a luteinizing hormone-releasing hormone agonist plus an anti and rogen ) and a st and ard dose of radiation therapy at that time . Patient characteristics were well balanced in regard to age , stage , prostate specific antigen and Gleason score . No biochemical evidence of disease ( BNED ) was defined as an end point according to the Vancouver rule . RESULTS In the study 1 at a median followup of 5 years 7-year biochemical-free survival rates were 42 % , 66 % and 69 % in groups 1 to 3 , respectively . BNED was significantly different between groups 1 and 2 ( p = 0.009 ) and between groups 1 and 3 ( p = 0.003 ) but not between groups 2 and 3 ( p = 0.6 ) . Multivariate analysis using a Cox proportional hazards model showed an HR of 6.1 for Gleason score ( p = 0.001 ) , 1.4 for PSA ( p = 0.002 ) , 0.5 for group 1 vs group 2 ( p = 0.01 ) and 0.35 for group 1 vs group 3 ( p = 0.008 ) . In study 2 BNED at 4 years was 65 % . There was no significant difference between arms 1 and 2 ( p = 0.55 ) . CONCLUSIONS The analysis of study 1 shows a benefit of using a short course of neoadjuvant AS with EBRT vs EBRT alone for localized T2-T3 prostate cancers . Moreover , in each study adding a short course of adjuvant AS after neoadjuvant 1 provided no more advantage in these patients BACKGROUND We conducted a r and omized , prospect i ve trial comparing external irradiation with external irradiation plus goserelin ( an agonist analogue of gonadotropin-releasing hormone that reduces testosterone secretion ) in patients with locally advanced prostate cancer . METHODS From 1987 to 1995 , 415 patients with locally advanced prostate cancer were r and omly assigned to receive radiotherapy alone or radiotherapy plus immediate treatment with goserelin . The patients had a median age of 71 years ( range , 51 to 80 ) . Patients in both groups received 50 Gy of radiation to the pelvis over a period of five weeks and an additional 20 Gy over an additional two weeks as a prostatic boost . Patients in the combined-treatment group received 3.6 mg of goserelin ( Zoladex ) subcutaneously every four weeks starting on the first day of irradiation and continuing for three years ; those patients also received cyproterone acetate ( 150 mg orally per day ) during the first month of treatment to inhibit the transient rise in testosterone associated with the administration of goserelin . RESULTS Data were available for analysis on 401 patients . The median follow-up was 45 months . Kaplan-Meier estimates of overall survival at five years were 79 percent ( 95 percent confidence interval , 72 to 86 percent ) in the combined-treatment group and 62 percent ( 95 percent confidence interval , 52 to 72 percent ) in the radiotherapy group ( P=0.001 ) . The proportion of surviving patients who were free of disease at five years was 85 percent ( 95 percent confidence interval , 78 to 92 percent ) in the combined-treatment group and 48 percent ( 95 percent confidence interval , 38 to 58 percent ) in the radiotherapy group ( P<0.001 ) . CONCLUSIONS Adjuvant treatment with goserelin , when started simultaneously with external irradiation , improves local control and survival in patients with locally advanced prostate cancer PURPOSE To test the hypothesis that increasing radiation dose delivered to men with early-stage prostate cancer improves clinical outcomes . PATIENTS AND METHODS Men with T1b-T2b prostate cancer and prostate-specific antigen < /= 15 ng/mL were r and omly assigned to a total dose of either 70.2 Gray equivalents ( GyE ; conventional ) or 79.2 GyE ( high ) . No patient received and rogen suppression therapy with radiation .  Local failure ( LF ) , biochemical failure ( BF ) , and overall survival ( OS ) were outcomes . Results A total of 393 men were r and omly assigned , and median follow-up was 8.9 years . Men receiving high-dose radiation therapy were significantly less likely to have LF , with a hazard ratio of 0.57 . The 10-year American Society for Therapeutic Radiology and Oncology BF rates were 32.4 % for conventional-dose and 16.7 % for high-dose radiation therapy ( P < .0001 ) . This difference held when only those with low-risk disease ( n = 227 ; 58 % of total ) were examined : 28.2 % for conventional and 7.1 % for high dose ( P < .0001 ) . There was a strong trend in the same direction for the intermediate-risk patients ( n = 144 ; 37 % of total ; 42.1 % v 30.4 % , P = .06 ) . Eleven percent of patients subsequently required and rogen deprivation for recurrence after conventional dose compared with 6 % after high dose ( P = .047 ) . There remains no difference in OS rates between the treatment arms ( 78.4 % v 83.4 % ; P = .41 ) . Two percent of patients in both arms experienced late grade > /= 3 genitourinary toxicity , and 1 % of patients in the high-dose arm experienced late grade > /= 3 GI toxicity . CONCLUSION This r and omized controlled trial shows superior long-term cancer control for men with localized prostate cancer receiving high-dose versus conventional-dose radiation . This was achieved without an increase in grade > /= 3 late urinary or rectal morbidity PURPOSE In a r and omized study we compared the combination of orchiectomy and radiotherapy to radiotherapy alone as treatment for locally advanced prostate cancer . Patients who were treated only with radiotherapy  initially underwent castration therapy at clinical progression , providing the opportunity to compare immediate vs deferred endocrine intervention . MATERIAL S AND METHODS In this prospect i ve study 91 patients with locally advanced prostate cancer were r and omized to receive external beam radiotherapy ( 46 ) or combined orchiectomy and radiotherapy ( 45 )  after surgical lymph node staging .  Survival rates were calculated . RESULTS During 14 to 19 years of followup 87 % of the patients in the radiotherapy group and 76 % in the combined orchiectomy and radiotherapy group died ( log rank p = 0.03 ) . Prostate cancer mortality was 57 % and 36 % , respectively ( log rank p = 
    Output:
    
There was a statistically significant advantage to the use of and rogen suppression , in terms of both overall survival and disease free survival , when compared to radiotherapy alone .
The use of long-term goserelin ( up to three years ) was the strategy providing the higher magnitude of clinical benefit .
Complete hormonal blockade was not shown to be superior to goserelin monotherapy .
Conclusions Based on the findings of this systematic review , the evidence supports the use of and rogen suppression with goserelin monotherapy as the st and ard treatment for patients with prostate cancer treated with radiotherapy  , which are at high risk of recurrence or metastases