***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: Aim . To study whether use of neoadjuvant and rogen deprivation therapy ( N-ADT ) combined with whole pelvic radiotherapy ( WPRT ) for high-risk prostate cancer patients was associated with survival benefit over prostate radiotherapy ( PORT ) only . Material and Methods . Between 1999 and 2004 , 162 high-risk prostate cancer patients were treated with radiotherapy combined with long-term and rogen deprivation therapy ( L-ADT ) . Patients were prospect ively assigned into two groups : A ( N-ADT + WPRT + L-ADT ) n = 70 pts , B ( PORT + L-ADT ) n = 92 pts . Results . The 5-year actuarial overall survival ( OS ) rates were 89 % for A and 78 % for B ( P = .13 ) . The 5-year actuarial cause specific survival ( CSS ) rates were A = 90 % and B = 79 % ( P = .01 ) . Biochemical progression-free survival ( bPFS ) rates were 52 % versus 40 % ( P = .07 ) , for groups A and B , respectively . Conclusions . The WPRT combined with N-ADT compared to PORT for high-risk patients result ed in improvement in CSS and bPFS ; however no OS benefit was observed PURPOSE To evaluate survival and time to metastatic disease in patients treated for localized prostatic carcinoma in a Phase III radiotherapy ( RT ) protocol , Radiation Therapy Oncology Group ( RTOG ) 77 - 06 . Patients with T18N0M0 ( A2 ) or T2N0M0 ( B ) disease after lymphangiogram ( LAG ) or staging laparotomy ( SL ) were r and omized between prophylactic radiation to the pelvic lymph nodes and prostatic bed vs. prostatic bed alone . The outcome of both treatment arms , as well as a comparison of the LAG group , to that of the SL group , are up date d. METHODS AND MATERIAL S A total of 449 eligible males were entered into RTOG protocol 7706 between 1978 and 1983 . Lymph node staging was m and atory but at the physician 's discretion ; 117 ( 26 % ) patients had SL , while 332 ( 74 % ) had LAG . Follow-up was a median of 12 years and a maximum of 16 years . For those r and omized to receive prophylactic pelvic lymph nodal irradiation , 45 Gy of megavoltage RT was delivered via multiple portals in 4.5 - 5 weeks , while all patients received 65 Gy in 6.5 - 8 weeks to the prostatic bed . RESULTS There was no significant difference in survival whether treatment was administered to the prostate or prostate and pelvic lymph nodes . The SL group had greater 12-year survival than the LAG group ( 48 % vs. 38 % , p = 0.02 ) . Disease-free survival was statistically significant , with 38 % for the SL group vs. 26 % for the LAG group ( p = 0.003 ) . Bone metastasis was less common in the SL group ( 14 % ) than the LAG group ( 27 % ) ( p = 0.003 ) . CONCLUSION At 12-year median follow-up , there still was no survival difference in those patients treated prophylactically to the pelvic nodes and prostatic bed vs. the prostatic bed alone . Those patients not surgically staged with only LAG for lymph node evaluation were less accurately staged , as reflected by a statistically significant reduced survival and earlier metastases BACKGROUND Several trials evaluating the effect of prostate-specific antigen ( PSA ) testing on prostate-cancer mortality have shown conflicting results . We up date d prostate-cancer mortality in the European R and omized Study of Screening for Prostate Cancer with 2 additional years of follow-up . METHODS The study involved 182,160 men between the ages of 50 and 74 years at entry , with a predefined core age group of 162,388 men 55 to 69 years of age . The trial was conducted in eight European countries . Men who were r and omly assigned to the screening group were offered PSA-based screening , whereas those in the control group were not offered such screening . The primary outcome was mortality from prostate cancer . RESULTS After a median follow-up of 11 years in the core age group , the relative reduction in the risk of death from prostate cancer in the screening group was 21 % ( rate ratio , 0.79 ; 95 % confidence interval [ CI ] , 0.68 to 0.91 ; P=0.001 ) , and 29 % after adjustment for noncompliance . The absolute reduction in mortality in the screening group was 0.10 deaths per 1000 person-years or 1.07 deaths per 1000 men who underwent r and omization . The rate ratio for death from prostate cancer during follow-up years 10 and 11 was 0.62 ( 95 % CI , 0.45 to 0.85 ; P=0.003 ) . To prevent one death from prostate cancer at 11 years of follow-up , 1055 men would need to be invited for screening and 37 cancers would need to be detected . There was no significant between-group difference in all-cause mortality . CONCLUSIONS Analyses after 2 additional years of follow-up consoli date d our previous finding that PSA-based screening significantly reduced mortality from prostate cancer but did not affect all-cause mortality . ( Current Controlled Trials number , IS RCT N49127736 . ) PURPOSE To ascertain the reliability of computed tomography ( CT ) and CT-guided fine-needle aspiration biopsy ( FNAB ) in staging of lymph nodes in patients with locally confined prostatic carcinoma . MATERIAL S AND METHODS A total of 285 patients were studied prospect ively .  FNAB was performed in 43 patients ( 15 % ) with lymph nodes suspect for metastasis on CT scans . FNAB findings were correlated with either the findings of the pathologic examination performed after lymph node dissection ( LND ) or the status of the lymph node at follow-up with CT after hormone therapy . RESULTS The sensitivity , specificity , and accuracy of CT-guided FNAB were 77.8 % , 100 % , and 96.5 % . If CT only had been performed , these results would have been 77.8 % , 96.7 % , and 93.7 % . CT staging was false-negative in only 10 patients , who had microscopic metastatic deposits in a solitary lymph node . CONCLUSION Combined CT and FNAB is highly efficient for assessment of lymph node metastasis . Therefore , it could be considered an alternative to surgical or laparoscopic lymphadenectomy in patients scheduled for radical prostatectomy or curative radiation therapy BACKGROUND The British Columbia r and omized radiation trial was design ed to determine the survival impact of locoregional radiation therapy in premenopausal patients with lymph node-positive breast cancer treated by modified radical mastectomy and adjuvant chemotherapy . Three hundred eighteen patients were assigned to receive no further therapy or radiation therapy ( 37.5 Gy in 16 fractions ) . Previous analysis at the 15-year follow-up showed that radiation therapy was associated with a statistically significant improvement in breast cancer survival but that improvement in overall survival was of only borderline statistical significance . We report the analysis of data from the 20-year follow-up . METHODS Survival was analyzed by the Kaplan-Meier method . Relative risk estimates were calculated by the Wald test from the proportional hazards regression model . All statistical tests were two-sided . RESULTS At the 20 year follow up ( median follow up for live patients : 249 months ) chemotherapy and radiation therapy , compared with chemotherapy alone , were associated with a statistically significant improvement in all end points analyzed , including survival free of isolated locoregional recurrences ( 74 % versus 90 % , respectively ; relative risk [ RR ] = 0.36 , 95 % confidence interval [ CI ] = 0.18 to 0.71 ; P = .002 ) , systemic relapse-free survival ( 31 % versus 48 % ; RR = 0.66 , 95 % CI = 0.49 to 0.88 ; P = .004 ) , breast cancer-free survival ( 48 % versus 30 % ; RR = 0.63 , 95 % CI = 0.47 to 0.83 ; P = .001 ) , event-free survival ( 35 % versus 25 % ; RR = 0.70 , 95 % CI = 0.54 to 0.92 ; P = .009 ) , breast cancer-specific survival ( 53 % versus 38 % ; RR = 0.67 , 95 % CI = 0.49 to 0.90 ; P = .008 ) , and , in contrast to the 15-year follow-up results , overall survival ( 47 % versus 37 % ; RR = 0.73 , 95 % CI = 0.55 to 0.98 ; P = .03 ) . Long-term toxicities , including cardiac deaths ( 1.8 % versus 0.6 % ) , were minimal for both arms . CONCLUSION For patients with high-risk breast cancer treated with modified radical mastectomy , treatment with radiation therapy ( schedule of 16 fractions ) and adjuvant chemotherapy leads to better survival outcomes than chemotherapy alone , and it is well tolerated , with acceptable long-term toxicity PURPOSE To investigate the relation between acute toxicity and irradiated volume in the organs at risk during three-dimensional conformal radiation therapy for prostate cancer . METHODS AND MATERIAL S From January to December 2001 , we treated 132 prostate cancer patients to a prescribed target dose of 70 Gy . Twenty-six patients ( 20 % ) received irradiation to the prostate only ( Group P ) , 86 patients ( 65 % ) had field arrangements encompassing the prostate and seminal vesicles ( Group PSV ) while 20 ( 15 % ) received modified pelvic fields ( Group MPF ) . A four-field conformal box technique was used . Acute toxicity according to the RTOG scoring system was prospect ively recorded throughout the course of treatment . RESULTS Overall , radiation was well tolerated with 11 % , 16 % and 35 % Grade 2 gastro-intestinal ( GI ) toxicity and 19 % , 34 % and 35 % Grade 2 or higher genito-urinary ( GU ) toxicity in Groups P , PSV and MPF , respectively . In univariate and multivariate analyses treatment group was a significant predictor for Grade 2 or higher acute morbidity . In multivariate logistic regression , the rectum dose-volume histogram parameters were correlated to the incidence of acute Grade 2 GI toxicity , with the fractional volumes receiving more than 37 - 40 Gy and above 70 Gy showing the statistically strongest correlation . The fractional bladder volume receiving more than 14 - 27 Gy showed the statistically strongest correlation with acute GU toxicity . CONCLUSIONS 3D-CRT radiation therapy to 70 Gy for prostate cancer was well tolerated . Only two of the 132 patients in the cohort experienced acute bladder toxicity Grade 3 , none had Grade 3 rectal toxicity . Uni- and multivariate analyses indicated that the volume treated was a significant factor for the incidence of Grade 2 or higher acute morbidity PURPOSE The Radiation Therapy Oncology Group ( RTOG ) 9413 trial demonstrated a better progression-free survival ( PFS ) with whole-pelvis ( WP ) radiotherapy ( RT ) compared with prostate-only ( PO ) RT . This secondary analysis was undertaken to determine whether " mini-pelvis " ( MP ; defined as > or = 10 x 11 cm but < 11 x 11 cm ) RT result ed in progression-free survival ( PFS ) comparable to that of WP RT . To avoid a timing bias , this analysis was limited to patients receiving neoadjuvant and concurrent hormonal therapy ( N&CHT ) in Arms 1 and 2 of the study . METHODS AND MATERIAL S Eligible patients had a risk of lymph node ( LN ) involvement > 15 % .  Neoadjuvant and concurrent hormonal therapy ( N&CHT ) was administered 2 months before and during RT for 4 months . From April 1 , 1995 , to June 1 , 1999 , a group of 325 patients were r and omized to WP RT + N&CHT and another group of 324 patients were r and omized to receive PO RT + N&CHT . Patients r and omized to PO RT were dichotomized by median field size ( 10 x 11 cm ) , with the larger field considered an " MP " field and the smaller a PO field . RESULTS The median PFS was 5.2 , 3.7 , and 2.9 years for WP , MP , and PO fields , respectively ( p = 0.02 ) . The 7-year PFS was 40 % , 35 % , and 27 % for patients treated to WP , MP , and PO fields , respectively . There was no association between field size and late Grade 3 + genitourinary toxicity but late Grade 3 + gastro 
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This review will address the difficulty of non-invasive nodal staging , even with more advanced imaging techniques , and will show that surgical staging still finds a relatively high percentage of patients with intermediate- or high-risk prostate cancer that have microscopic tumor invasion in the pelvic nodes .