***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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    ***EXAMPLES*** 
    Input: PURPOSE Nonr and omized clinical trials have suggested that preoperative and rogen deprivation can decrease the likelihood of positive surgical margins in patients with clinical ly localized prostate cancer . A multicenter prospect i ve r and omized trial compared radical prostatectomy alone to radical prostatectomy after 3 months of leuprolide acetate depot and flutamide in patients with stage cT2bNxM0 prostate cancer and a serum prostate specific antigen level less than 50 ng./ml . MATERIAL S AND METHODS We r and omized 149 patients to undergo and rogen deprivation and 138 to undergo lymphadenectomy with ( 137 ) or without ( 1 ) prostatectomy .  Of the 154 patients r and omized to the surgery alone group 144 underwent pelvic node dissection with ( 138 ) or without ( 6 ) prostatectomy . RESULTS There was no statistically significant difference between the 2 groups in operating time , blood loss , need for transfusion , postoperative morbidity or length of hospital stay . There were 4 rectal and 2 ureteral injuries in the surgery alone group and none in the pretreatment group ( p < 0.05 ) . Patients who received and rogen deprivation preoperatively had a significantly lower rate of capsule penetration ( 47 % versus 78 % , p < 0.001 ) , positive surgical margins ( 18 % versus 48 % , p < 0.001 ) and tumor at the urethral margin ( 6 % versus 17 % , p < 0.01 ) . CONCLUSIONS Long-term followup data will be needed to determine whether there will be a lower incidence of biochemical relapse as determined by prostate specific antigen , local recurrence or metastasis , with an improvement in patient survival 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 PURPOSE To determine the potential advantage of and rogen ablation following st and ard external-beam radiation therapy in patients with locally advanced ( clinical or pathologic T3 ; clinical or pathologic node positive ) carcinoma of the prostate . METHODS AND MATERIAL S In 1987 the RTOG initiated a Phase III trial of long-term adjuvant goserelin in definitively irradiated patients with carcinoma of the prostate . A total of 977 patients were accrued to the study of which 945 remain analyzable : 477 on the adjuvant hormone arm ( Arm I ) ; and 468 on the radiation only arm ( Arm II ) with hormones  initiated at relapse . The initial results were reported in the Journal of Clinical Oncology in 1997 . RESULTS With a median follow up of 5.6 years for all patients and 6.0 years for living patients local failure at 8 years was 23 % for Arm I and 37 % for Arm II ( p < 0.0001 ) . Distant metastasis was likewise favorably impacted with the immediate use of hormonal manipulation with a distant metastasis rate in Arm I of 27 % and 37 % in Arm II ( p < 0.0001 ) . Disease-free survival ( NED survival ) and NED survival with PSA of 1.5 ng/mL ( bNED ) or less were both statistically significant in favor of the immediate hormone arm ( both p < 0.0001 ) . Cause-specific failure was not statistically different with a cause-specific failure of 16 % for Arm I and 21 % in Arm II ( p = 0.23 ) . Overall survival was likewise not statistically different between two arms , with a 49 % overall survival at 8 years in Arm I and 47 % in Arm II ( p = 0.36 ) . Subset analysis of central ly review ed Gleason 8 - 10 patients who did not undergo prostatectomy showed that for patients receiving radiation therapy plus adjuvant hormones there was a statistically significant improvement in both absolute ( p = 0.036 ) and cause-specific survival ( p = 0.019 ) . CONCLUSIONS Use of long-term adjuvant and rogen deprivation in addition to definitive radiation therapy results in a highly significant improvement in regards to local control , freedom from distant metastasis , and biochemical free survival in unfavorable prognosis patients with carcinoma of the prostate PURPOSE In 1992 we initiated a national r and omized prospect i ve trial of 3 months of cyproterone acetate before radical prostatectomy compared to prostatectomy alone . Initial results indicated a 50 % decrease in the rate of positive surgical margins . This decrease did not translate into a difference in prostate specific antigen ( PSA ) progression at 3 years . This report is on the long-term outcome ( median followup 6 years ) of this cohort . MATERIAL S AND METHODS This prospect i ve , r and omized , open label trial compared 100 mg cyproterone acetate 3 times daily for 3 months before surgery to surgery alone . R and omization occurred between January 1993 and April 1994 . Patients were stratified according to clinical stage , baseline serum PSA and Gleason sum . A total of 213 patients were accrued . Biochemical progression was defined as 2 consecutive detectable PSAs ( greater than 0.2 ng/ml ) at least 4 weeks apart , re-treatment or death from prostate cancer . RESULTS A total of 34 ( 33.6 % ) patients undergoing surgery only and 42 ( 37.5 % ) patients given neoadjuvant hormone therapy ( NHT ) had biochemical recurrence during the median followup of 6 years . Despite the significant pathological down staging in this study , there was no significant difference in number of patients with no evidence of biochemical disease ( bNED ) survival ( p = 0.732 ) . A bNED survival benefit favoring NHT was seen in men with a baseline PSA greater than 20 ( p = 0.015 ) . CONCLUSIONS After 6 years of followup there was no overall benefit with 3 months of NHT . Improved bNED survival was seen in the highest risk PSA group ( PSA greater than 20 ) . The possibility that high risk patients may benefit from NHT warrants further investigation Objectives : To assess the effect of neoadjuvant hormone treatment before radical prostatectomy on : tumor/prostate volume , prostate-specific antigen ( PSA ) and testosterone levels , surgical margin status and tumor stage , and the ease of surgery following treatment . Methods : Patients with clinical ly localized prostatic carcinoma were r and omized to receive leuprolide acetate depot 3.75 mg once a month for 3 months and cyproterone acetate 300 mg once a week for 3 weeks prior to surgery ( group A ) . A control group of patients had surgery without any pretreatment ( group B ) . Results : 167 patients were evaluated for the efficacy parameters . In group A , 31 % of patients had a reduction in tumor/prostate volume following hormone therapy . PSA and testosterone levels were significantly reduced ( p = 0.0001 ) in patients in group A compared to basal values . Central ized histopathological data evaluated in 145 patients ( group A and 75 group B ) showed that more patients in group B had tumors at stages T3A and T3B than in group A ; this difference was close to significance ( p = 0.057 ) . Positive surgical margins were more common in group B ( 60 % of patients ) compared to group A ( 39 % of patients ) . Similarly lymph node involvement was more common in group B compared to group A ( 11 versus 3 % ) . There was little difference between the 2 study groups for the other surgical parameters assessed ( ease of dissection , duration of surgery , blood loss ) . Conclusions : Neoadjuvant hormone therapy before radical prostatectomy has some effects in the treatment of prostate cancer . However , long-term follow-up of patients is needed to assess the impact of this therapy on morbidity and mortality PURPOSE Radiation Therapy Oncology Group ( RTOG ) Protocol 92 - 02 was a r and omized trial testing long-term ( LT ) adjuvant and rogen deprivation ( AD ) after initial AD with external-beam radiotherapy ( RT ) in patients with locally advanced prostate cancer ( PC ; T2c-4 ) and with prostate-specific antigen level less than 150 ng/mL. PATIENTS AND METHODS Patients received a total of 4 months of goserelin and flutamide , 2 months before and 2 months during RT . A radiation dose of 65 to 70 Gy was given to the prostate and a dose of 44 to 50 Gy to the pelvic lymph nodes . Patients were r and omly assigned to receive no additional therapy ( short-term [ST]AD-RT ) or 24 months of goserelin ( LTAD-RT ) ; 1,554 patients were entered onto the study . RESULTS The LTAD-RT arm showed significant improvement in all efficacy end points except overall survival ( OS ; 80.0 % v 78.5 % at 5 years , P = .73 ) , compared with the STAD-RT arm . In a subset of patients not part of the original study design , with tumors assigned Gleason scores of 8 to 10 by the contributing institutions , the LTAD-RT arm had significantly better OS ( 81.0 % v 70.7 % , P = .044 ) . There was a small but significant increase in the frequency of late radiation grade s 3 , 4 , and 5 gastrointestinal toxicity ascribed to the LTAD-RT arm ( 2.6 % v 1.2 % at 5 years , P = .037 ) , the cause of which is not clear . CONCLUSION The RTOG 92 - 02 trial supports the addition of LT adjuvant AD to STAD with RT for T2c-4 PC . In the exploratory subset analysis of patients with Gleason scores 8 to 10 , LT adjuvant AD result ed in a survival advantage PURPOSE We determined whether 12 weeks of neoadjuvant testicular and rogen ablation therapy using a luteinizing hormone-releasing hormone agonist could improve pathological outcomes in men undergoing radical retropubic prostatectomy for clinical ly localized ( stages T1C , T2A and T2B ) prostatic carcinoma . MATERIAL S AND METHODS A total of 56 participants was r and omized to receive either monthly injections of a luteinizing hormone-releasing hormone agonist at 4-week intervals followed by radical retropubic prostatectomy ( 28 ) or to undergo immediate radical retropubic prostatectomy alone ( 28 ) . Operations were performed via similar technique and all prostatic specimens were processed histologically in their entirety . RESULTS There was no improvement in pathological outcome using luteinizing hormone-releasing hormone agonist preoperatively compared to surgery alone . Of 28 men undergoing immediate 
    Output:
    
Conclusions Patients with aggressive prostate cancer would better benefit from the receipt of neo-adjuvant therapy .