***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: PURPOSE Radiation Therapy Oncology Group protocol 85 - 31 was design ed to evaluate the effectiveness of adjuvant and rogen suppression , using goserelin , in unfavorable prognosis carcinoma of the prostate treated with definitive radiotherapy ( RT ) . METHODS AND MATERIAL S Eligible patients were those with palpable primary tumor extending beyond the prostate ( clinical Stage T3 ) or those with regional lymphatic involvement . Patients who had undergone prostatectomy were eligible if penetration through the prostatic capsule to the margin of resection and /or seminal vesicle involvement was documented histologically . Stratification was based on histologic differentiation , nodal status , acid phosphatase status , and prior prostatectomy . The patients were r and omized to either RT and adjuvant goserelin ( Arm I ) or RT alone followed by observation and application of goserelin at relapse ( Arm II ) . In Arm I , the drug was to be started during the last week of RT and was to be continued indefinitely or until signs of progression . RESULTS Between 1987 and 1992 , when the study was closed , 977 patients were entered : 488 to Arm I and 489 to Arm II . As of July 2003 , the median follow-up for all patients was 7.6 years and for living patients was 11 years . At 10 years , the absolute survival rate was significantly greater for the adjuvant arm than for the control arm : 49 % vs. 39 % , respectively ( p = 0.002 ) . The 10-year local failure rate for the adjuvant arm was 23 % vs. 38 % for the control arm ( p < 0.0001 ) . The corresponding 10-year rates for the incidence of distant metastases and disease-specific mortality was 24 % vs. 39 % ( p < 0.001 ) and 16 % vs. 22 % ( p = 0.0052 ) , respectively , both in favor of the adjuvant arm . CONCLUSION In a population of patients with unfavorable prognosis carcinoma of the prostate , and rogen suppression applied as an adjuvant after definitive RT was associated not only with a reduction in disease progression but in a statistically significant improvement in absolute survival . The improvement in survival appeared preferentially in patients with a Gleason score of 7 - 10 CONTEXT Clinical ly localized prostate cancer is very prevalent among US men , but recurrence after treatment with conventional radiation therapy is common . OBJECTIVE To evaluate the hypothesis that increasing the radiation dose delivered to men with clinical ly localized prostate cancer improves disease outcome . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 393 patients with stage T1b through T2b prostate cancer and prostate-specific antigen ( PSA ) levels less than 15 ng/mL r and omized between January 1996 and December 1999 and treated at 2 US academic institutions . Median age was 67 years and median PSA level was 6.3 ng/mL. Median follow-up was 5.5 ( range , 1.2 - 8.2 ) years . INTERVENTION Patients were r and omized to receive external beam radiation to a total dose of either 70.2 Gy ( conventional dose ) or 79.2 Gy ( high dose ) . This was delivered using a combination of conformal photon and proton beams . MAIN OUTCOME MEASURE Increasing PSA level ( ie , biochemical failure ) 5 years after treatment . RESULTS The proportions of men free from biochemical failure at 5 years were 78.8 % [ corrected ] ( 95 % confidence interval , 73.1%-84.6 % ) [ corrected ] for conventional-dose and 91.3 % [ corrected ] ( 95 % confidence interval , 87.2%-95.4 % ) [ corrected ] for high-dose therapy ( P<.001 ) , a 59 % [ corrected ] reduction in the risk of failure . The advantage to high-dose therapy was statistically significant [ corrected ] in both the low-risk subgroup [ corrected ] ( risk reduction , 84 % [ P<.001 ] ) [ corrected ] There has been no significant difference in overall survival rates between the treatment groups . Only 1 % of patients receiving conventional-dose and 2 % receiving high-dose radiation experienced acute urinary or rectal morbidity of Radiation Therapy Oncology Group ( RTOG ) grade 3 or greater . So far , only 2 % and 1 % , respectively , have experienced late morbidity of RTOG grade 3 or greater . CONCLUSIONS Men with clinical ly localized prostate cancer have a lower risk of biochemical failure if they receive high-dose rather than conventional-dose conformal radiation . This advantage was achieved without any associated increase in RTOG grade 3 acute or 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 = 0.02 ) . The difference in favor of combined treatment was mainly caused by lymph node positive tumors . For node negative tumors there was no significant difference in the survival rates . CONCLUSIONS Immediate and rogen deprivation should be considered instead of deferred endocrine treatment started at clinical progression for prostate cancer with spread to regional lymph nodes . While awaiting evidence from r and omized trials , one should consider full dose radiotherapy for local control of locally advanced prostate cancer even when it is lymph node positive PURPOSE To determine if immediate hormonal therapy is advantageous compared with deferred treatment in newly diagnosed asymptomatic prostate cancer patients who , for any reason , were not c and i date s for curative local treatment . PATIENTS AND METHODS Between February 1988 and February 1992 , 197 patients with a median age of 76 years ( range , 56 to 86 years ) were r and omly assigned to receive either immediate or deferred orchiectomy on symptomatic progression . The two groups did not differ significantly in clinical or laboratory parameters ; 67 % had T3 - 4 tumors and 20 % had lymph node metastases . Patient accrual was stopped prematurely because of a similar competing trial . Therefore , observation time was prolonged to achieve the desired number of events and statistical power . RESULTS Deferred orchiectomy was necessary in 58 % of the patients . Median time to disease progression was 2.8 years less than for patients with immediate orchiectomy . However , overall pain-free time from r and om assignment to symptomatic progression after immediate or deferred orchiectomy , and performance status , were identical in both groups . Cancer-specific survival tended to be longer in the immediate group ( P = .09 ) but there was no difference in overall survival between the two groups ( P = .96 ) . The median hemoglobin value decreased significantly after immediate orchiectomy ( P < .001 ) . CONCLUSION For elderly , asymptomatic patients not undergoing curative local treatment , we were unable to show any major advantage of immediate compared with deferred hormonal treatment regarding quality of life or overall survival in our limited number of patients . Disabling complications were prevented in the deferred-treatment arm by careful follow-up ; 42 % of these patients never required any tumor-specific treatment OBJECTIVE To assess the efficacy and the tolerability of flutamide as adjuvant treatment after radical prostatectomy for locally advanced , lymph node-negative prostate cancer . METHODS Men with locally advanced , lymph node-negative prostate cancer were r and omized after radical prostatectomy  to receive either flutamide 750 mg daily or no adjuvant treatment .  Recurrence-free and overall survival were the study end points . Recurrence was defined as a PSA value greater than 5ng/ml or two values greater than 2ng/ml more than three months apart with increasing tendency or three values greater than 1ng/ml more than three months apart with increasing tendency or any clinical recurrence . RESULTS 309 patients ( 157 in the control arm and 152 in the flutamide arm ) were eligible for efficacy analysis . The median follow-up was 6.1 years . Recurrence-free survival was better in the flutamide group ( P=0.0041 ) , there was , however , no detectable difference in overall survival ( p=0.92 ) . Moreover , there was a considerable toxicity reported in the flutamide group . CONCLUSION Although having some effect on disease recurrence , adjuvant flutamide treatment does not improve median-term overall survival after radical prostatectomy for locally advanced , lymph node-negative prostate cancer PURPOSE To test the hypothesis that and rogen ablation before and during radiotherapy for locally advanced carcinoma of the prostate may , by reducing tumor bulk and enhancing tumor cell kill , improve locoregional control and ultimately survival . METHODS AND MATERIAL S The study was conducted from 1987 to 1991 . Eligible patients were those with bulky tumors ( T2 - -T4 ) with or without pelvic lymph node involvement and without evidence of distant metastases . They were r and omized to receive goserelin , 3.6 mg every 4 weeks ; and flutamide , 250 mg t.i.d . for 2 months before radiation therapy and during radiation therapy ( Arm I ) , or radiation therapy alone ( Arm II ) . Of 471 r and omized patients , 456 were evaluable : 226 on Arm I and 230 on Arm II . RESULTS As of November 1999 , the median follow-up has reached 6.7 years for all patients and 8.6 years for alive patients . At 8 years , and rogen ablation has been associated with an improvement in local control ( 42 % vs. 30 % , p = 0.016 ) , reduction in the incidence of distant metastases ( 34 % vs. 45 % , p = 0.04 ) , disease-free survival ( 33 % vs. 21 % , p = 0.004 ) , biochemical disease-free survival = PSA < 1.5 ( 24 % vs. 10 % , p < 0.0001 ) , and cause-specific mortality ( 23 % vs. 31 % , p = 0.05 ) . However , subset analysis indicates that the beneficial effect of short-term and rogen ablation appears preferentially in patients with Gleason score 2 - -6 . In that population , there is a highly significant improvement in all endpoints , including survival ( 70 % vs. 52 % , p = 0.015 ) . In patients with Gleason 7 - -10 tumors , the regimen has not result ed in a significant enhancement in either locoregional control or survival . CONCLUSION In patients with Gleason score 2 - -6 carcinoma of the prostate , a short course of and rogen ablation administered before and during radiotherapy has been associated with a highly significant improvement in local control , reduction in disease progression , and overall survival OBJECTIVE EORTC trial 30891 compared immediate versus deferred and rogen-deprivation therapy ( ADT ) in T0 - 4 N0 - 2 M0 prostate cancer ( PCa ) . Many patients r and omly assigned to deferred ADT did not require ADT because they died before becoming symptomatic . The question arises whether serum prostate-specific antigen ( PSA ) levels may be used to decide when to initiate ADT in PCa not suitable for local curative treatment . METHODS PSA data at baseline , PSA doubling time ( PSADT ) in  patients receiving no ADT  , and time to PSA relapse ( > 2 ng/ml ) in patients whose PSA declined to < 2 ng/ml within the first year after immediate ADT  were analyzed in 939 eligible patients r and omly assigned to immediate ( n=468 ) or deferred ADT ( n=471 ) . RESULTS In both arms , patients with a baseline PSA>50 ng/ml were at a>3.5-fold higher risk to die of PCa than patients with a baseline PSA < or=8 ng/ml . If baseline PSA was between 8 and 50 ng/ml , the risk of PCa death was approximately 7.5-fold higher in patients with PSADT<12 mo than in patients with PSADT>12 mo . Time to PSA relapse after response to immediate ADT correlated significantly with baseline PSA , suggesting that baseline PSA may also reflect disease aggressiveness . CONCLUSIONS Patients with a baseline PSA>50 ng/ml and /or a PSADT<12 mo were at increased risk to die from PCa and might have benefited from immediate ADT , whereas patients with a baseline PSA<50 ng/ml and a slow PSADT ( > 12 mo ) were likely to die of causes unrelated to PCa , and thus could be spared the burden of immediate ADT PURPOSE This study ( EORTC 30891 ) attempted to demonstrate equivalent overall survival in patients with localized prostate cancer not suitable for local curative treatment treated with immediate or deferred and rogen ablation .  PATIENT 
    Output:
    
In contrast , ADT as an adjuvant to radiation therapy in patients with high-risk localised disease or locally advanced disease was associated with substantial OS and CSS benefits .
A similar benefit was seen in patients with proven systemic disease ( node-positive patients after radical prostatectomy ) .
We conclude that an interaction between local treatment and ADT is suggested by this systematic review .
In patients with advanced and aggressive disease who are at a high risk to die from PCa and who are treated for their primary tumour with curative intent , immediate and sustained ADT improves OS and CSS significantly .
However , this intensive treatment is unnecessary in a substantial number of patients with T3 and /or N1 disease with a slow natural history or high competing death risk