***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: OBJECTIVES To report an exploratory subgroup analysis assessing the extent to which the overall benefit found in the Early Prostate Cancer program is dependent on lymph node status at r and omization . The program is ongoing , and the overall survival data are immature . The first combined analysis of the bicalutamide ( Casodex ) Early Prostate Cancer program at 3 years ' median follow-up showed that bicalutamide , 150 mg once daily , plus st and ard care ( radical prostatectomy , radiotherapy , or watchful waiting ) , significantly reduced the risk of objective progression and prostate-specific antigen ( PSA ) doubling in patients with localized/locally advanced prostate cancer . METHODS Men ( n = 8113 ) with localized/locally advanced disease received bicalutamide 150 mg or placebo once daily , plus st and ard care . The time to event data ( objective progression , PSA doubling ) was analyzed by lymph node status at r and omization . RESULTS Compared with st and ard care alone , bicalutamide significantly reduced the risk of objective progression , irrespective of lymph node status , with the most pronounced reduction in patients with N+ ( hazard ratio [ HR ] 0.29 ; 95 % confidence interval [ CI ] 0.15 to 0.56 ) compared with those with N0 ( HR 0.59 ; 95 % CI 0.48 to 0.73 ) and Nx ( HR 0.60 ; 95 % CI 0.50 to 0.72 ) disease . The largest decrease in risk of PSA doubling with bicalutamide was observed in N+ disease ( HR 0.16 ; 95 % CI 0.09 to 0.29 ) , with significantly reduced risks seen in N0 ( HR 0.45 ; 95 % CI 0.40 to 0.51 ) and Nx ( HR 0.38 ; 95 % CI 0.33 to 0.44 ) disease . CONCLUSIONS The greatest reduction in the risk of objective progression and PSA doubling with bicalutamide was seen in patients with N+ disease . However , bicalutamide also provided a statistically significant benefit in those with N0 and Nx disease PURPOSE To evaluate the effect of immediate and rogen suppression in conjunction with st and ard external beam irradiation vs. radiation alone on a group of pathologically staged lymph node-positive patients with adenocarcinoma of the prostate . METHODS AND MATERIAL S A national prospect i ve r and omized trial ( RTOG 85 - 31 ) of st and ard external beam irradiation plus immediate and rogen suppression vs. external beam irradiation alone was initiated in 1985 for patients with locally advanced adenocarcinoma of the prostate . One hundred seventy-three of the patients in this trial had biopsy-proven pathologically involved lymph nodes . Ninety-eight of these patients received radiation plus the immediate and rogen suppression ( LHRH agonist ) , while 75 received radiation alone with hormonal manipulation instituted at the time of relapse . RESULTS With a median followup of 4.9 years , estimated progression-free survival with PSA < 1.5 ng/ml at 5 years was 55 % for the patients who received radiation plus immediate LHRH agonist vs. 11 % of the patients who received radiation alone with hormonal manipulation at relapse ( p = 0.0001 ) . Because all of these patients had locally advanced disease ( i.e. , pathologically positive lymph nodes ) , stage does not explain this difference in outcome , and Gleason grade was not statistically different between the two groups . Estimated absolute survival at 5 years for the radiation and LHRH group was 73 vs. 65 % for the radiation alone group who received and rogen suppression at relapse . Estimated disease-specific survival at 5 years was 82 % for the radiation and immediate LHRH agonist group and 77 % for the radiation-alone group . CONCLUSION Patients with adenocarcinoma of the prostate and pathologically involved pelvic lymph nodes ( pN+ or clinical stage D1 ) should be seriously considered for external beam irradiation plus immediate hormonal manipulation over radiation alone with hormonal manipulation at the time of relapse Concepts regarding the surgical treatment of cancer of the prostate have changed significantly at the Mayo Clinic . Rather than emphasizing radical prostatectomy only for low- grade ( grade less than or equal to 2 ) and low-stage ( less than or equal to T1/B1 ) lesions -- which may be equally well treated at less than ten years , in regard to crude survival , by radiotherapy -- we believe that radical prostatectomy is particularly suitable for lesions of higher local stages , including those with regional node extension . This view is based on a large experience ( less than 2,000 cases ) with the radical surgical treatment  of cancer of the prostate and on the realization that conservative single-modality treatment ( hormonal or radiotherapy ) for advanced local Stages ( C and D1 ) provides poor cause-specific survival and nonprogression rates and may lead to high local morbidity . The treatment of Stage D1 prostate cancer was thought to be not amenable to surgical treatment , and many have recommended observation only . In 266 patients ( mean age , 64 years ) followed one to twenty-one years ( mean , 4.7 years ) , immediate adjuvant orchiectomy at the time of radical prostatectomy performed in 162 patients ( 61 % ) result ed in a highly significant ( P less than 0.0001 ) decrease in progression compared with no immediate orchiectomy in 104 patients ( 39 % ) . The ten-year overall and local nonprogression rates for those undergoing immediate orchiectomy were 80 percent and 98 percent , respectively ; median time to progression for the no-immediate-orchiectomy group was less than 4.5 years , and the local recurrence rate was 25 percent at ten years . Of all the pathologic variables , only DNA ploidy pattern had a significant influence on progression and cause-specific survival . Also , in patients with D1 disease and a nuclear DNA diploid pattern , immediate adjuvant orchiectomy result ed in a nonprogression rate of 100 percent at ten years compared with virtually 0 percent in those with a nondiploid tumor and no immediate orchiectomy . Because 42 percent of the patients with D1 disease in the Mayo Clinic experience have DNA diploid tumors , adjuvant orchiectomy in this group results in no progression or prostate cancer death .  Patients with Stage D1 prostate cancer and DNA nondiploid pattern undergoing prostatectomy should be entered in prospect i ve adjuvant innovative treatment protocol s since these tumors do not seem to respond to early hormonal manipulation 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 4570 Purpose : We previously reported 7 year follow-up of men with clinical ly localized prostate cancer , who underwent radical prostatectomy ( RP ) and pelvic lymphadenectomy ( PLD ) and were found to have nodal metastases ( N+ ) , had significantly improved survival and disease-specific survival with immediate ( within 3 months of surgery ) and continuous hormonal monotherapy ( HT ) compared with those who had and rogen ablation withheld until distant metastases were identified ( NEJM 341:1781,1999 ) . To determine the durability of this effect , we up date results at 10 years median follow-up . METHODS 98 men were r and omized to receive Goserelin acetate or bilateral orchiectomy ( N=47 ) vs. observation  ( N=51 ) until distant disease was documented . Patients were followed with semi-annual exams and laboratory tests , and annual bone scans . RESULTS Patients were well-matched for age ( mean 65.9 yrs ) , prostate size , local extent , and Gleason score . Only 20 % of men had detectable PSA 's following their surgery at the time of r and omization . At median follow-up of 10 years , 13 of 47 men who received immediate HT  died ( 6 of prostate cancer , 7 of non-prostate cancer causes with undetectable PSA 's at the time of death ) vs 26 in the deferred arm ( 22 of prostate cancer , 4 of non-prostate cancer ) . The differences in both overall ( immediate 72.4 % ; deferred 49.0 % , p = .025 ) , and cause specific ( immediate : 87.2 % ; deferred : 56.9 % , p = .001 ) survivals , between the two arms were significant . Toxicities of treatment were tolerable , and at last follow-up , no immediately treated man had experienced an osteoporotic fracture or had discontinued HT . CONCLUSION 10 years , early HT in patients with N+ disease following RP+PLD continues to be associated with highly significant improvements in overall and disease-specific survival . The treatment has been generally well tolerated . Early HT 's role in other disease scenarios warrants testing in prospect i ve r and omized studies . No significant financial relationships to disclose 4628 Background : The Early Prostate Cancer ( EPC ) program is an ongoing study of the effect of adding bicalutamide ( CASODEX ) 150 mg to st and ard care ( radiotherapy [ RT ] , radical prostatectomy [ RP ] , or watchful waiting [ WW ] ) for men with localized or locally advanced prostate cancer . At a median 7.4 years ' follow-up , bicalutamide significantly improved objective progression-free survival ( PFS ) in men with locally advanced disease , irrespective of st and ard care , and improved overall survival in the RT setting . There was no PFS benefit in patients with localized disease . Lymph-node involvement is an established risk factor for progression , so we conducted an exploratory analysis among patients with locally advanced disease to assess the influence of this risk factor on PFS . METHODS The EPC program ( n = 8113 ) comprises 3 r and omized trials design ed for combined analysis . Patients with localized ( T1 - 2 , N0/Nx ) or locally advanced ( T3 - 4 , any N ; or any T , N+ ) non-metastatic prostate cancer received bicalutamide ( n = 4052 ) or placebo ( n = 4061 ) once daily plus st and ard care . This sub analysis studied the effect of nodal status ( N- , N+ , Nx ) in locally advanced disease . RESULTS In patients with locally advanced disease , PFS improvements were irrespective of nodal status . The treatment effect increased as the risk of progression increased from N- to Nx to N+ disease . The greatest reduction in risk was seen in RP patients with N+ disease . CONCLUSIONS The reduction in risk of progression with bicalutamide was seen irrespective of nodal status . The most significant reduction in risk of progression was in RP patients with N+ disease ; survival data by nodal status for these patients will be presented . [ Table : see text ] [ Table : see text ] BACKGROUND Appropriate timing of and rogen deprivation treatment ( ADT ) for prostate cancer is controversial . Our aim was to determine whether immediate ADT extends survival in men with node-positive prostate cancer who have undergone radical prostatectomy and pelvic lymphadenectomy compared with those who received ADT only once disease progressed . METHODS Eligible patients from 36 institutes in the USA were r and omly assigned in 1988 - 93 to receive immediate ADT ( n=47 ) or to be observed ( n=51 ) , with ADT to be given on detection of distant metastases or symptomatic recurrences . Patients were followed up every 3 months for the first year and every 6 months thereafter . The primary endpoint was progression-free survival ; secondary endpoints were overall and disease-specific survival . Analysis was by intention to treat . To ensure that the treatment groups were comparable , we did a retrospective central pathology review of slides and re grade d the Gleason scores for available sample s. This trial pre date s the requirement for clinical trial registration . FINDINGS At median follow-up of 11.9 years ( range 9.7 - 14.5 for surviving patients ) , men assigned immediate ADT had a significant improvement in overall survival ( hazard ratio 1.84 [ 95 % CI 1.01 - 3.35 ] , p=0.04 ) , prostate-cancer-specific survival ( 4.09 [ 1.76 - 9.49 ] , p=0.0004 ) , and progression-free 
    Output:
    
Conclusions The data available suggest an improvement in survival and delayed disease progression but increased adverse events for patients with node-positive prostate cancer after local therapy treated with early and rogen suppression therapy versus deferred and rogen suppression therapy .