***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: PURPOSE To investigate the benefit of chemotherapy in patients with symptomatic hormone-resistant prostate cancer using relevant end points of palliation in a r and omized controlled trial . PATIENTS AND METHODS We r and omized 161 hormone-refractory patients with pain to receive mitoxantrone plus prednisone or prednisone alone ( 10 mg daily ) . Nonresponding patients on prednisone  could receive mitoxantrone subsequently . The primary end point was a palliative response defined as a 2-point decrease in pain as assessed by a 6-point pain scale completed by patients ( or complete loss of pain if initially 1 + ) without an increase in analgesic medication and maintained for two consecutive evaluations at least 3 weeks apart . Secondary end points were a decrease of > or = 50 % in use of analgesic medication without an increase in pain , duration of response , and survival . Health-related quality of life was evaluated with a series of linear analog self- assessment scales ( LASA and the Prostate Cancer-Specific Quality -of-Life Instrument [ PROSQOLI ] ) , the core question naire of the European Organization for Research and Treatment of Cancer ( EORTC ) , and a disease-specific module . RESULTS Palliative response was observed in 23 of 80 patients ( 29 % ; 95 % confidence interval , 19 % to 40 % ) who received mitoxantrone plus prednisone , and in 10 of 81 patients ( 12 % ; 95 % confidence interval , 6 % to 22 % ) who received prednisone alone ( P = .01 ) . An additional seven patients in each group reduced analgesic medication > or = 50 % without an increase in pain . The duration of palliation was longer in patients who received chemotherapy ( median , 43 and 18 weeks ; P < .0001 , log-rank ) . Eleven of 50 patients r and omized to prednisone treatment responded after addition of mitoxantrone . There was no difference in overall survival . Treatment was well tolerated , except for five episodes of possible cardiac toxicity in 130 patients who received mitoxantrone . Most responding patients had an improvement in quality -of-life scales and a decrease in serum prostate-specific antigen ( PSA ) level . CONCLUSION Chemotherapy with mitoxantrone and prednisone provides palliation for some patients with symptomatic hormone-resistant prostate cancer BACKGROUND Enzalutamide ( formerly called MDV3100 ) targets multiple steps in the and rogen-receptor-signaling pathway , the major driver of prostate-cancer growth . We aim ed to evaluate whether enzalutamide prolongs survival in men with castration-resistant prostate cancer after chemotherapy . METHODS In our phase 3 , double-blind , placebo-controlled trial , we stratified 1199 men with castration-resistant prostate cancer after chemotherapy according to the Eastern Cooperative Oncology Group performance-status score and pain intensity . We r and omly assigned them , in a 2:1 ratio , to receive oral enzalutamide at a dose of 160 mg per day ( 800 patients ) or placebo ( 399 patients ) . The primary end point was overall survival . RESULTS The study was stopped after a planned interim analysis at the time of 520 deaths . The median overall survival was 18.4 months ( 95 % confidence interval [ CI ] , 17.3 to not yet reached ) in the enzalutamide group versus 13.6 months ( 95 % CI , 11.3 to 15.8 ) in the placebo group ( hazard ratio for death in the enzalutamide group , 0.63 ; 95 % CI , 0.53 to 0.75 ; P<0.001 ) . The superiority of enzalutamide over placebo was shown with respect to all secondary end points : the proportion of patients with a reduction in the prostate-specific antigen ( PSA ) level by 50 % or more ( 54 % vs. 2 % , P<0.001 ) , the soft-tissue response rate ( 29 % vs. 4 % , P<0.001 ) , the quality -of-life response rate ( 43 % vs. 18 % , P<0.001 ) , the time to PSA progression ( 8.3 vs. 3.0 months ; hazard ratio , 0.25 ; P<0.001 ) , radiographic progression-free survival ( 8.3 vs. 2.9 months ; hazard ratio , 0.40 ; P<0.001 ) , and the time to the first skeletal-related event ( 16.7 vs. 13.3 months ; hazard ratio , 0.69 ; P<0.001 ) . Rates of fatigue , diarrhea , and hot flashes were higher in the enzalutamide group . Seizures were reported in five patients ( 0.6 % ) receiving enzalutamide . CONCLUSIONS Enzalutamide significantly prolonged the survival of men with metastatic castration-resistant prostate cancer after chemotherapy . ( Funded by Medivation and Astellas Pharma Global Development ; AFFIRM Clinical Trials.gov number , NCT00974311 . ) Sub clinical prostate cancer is common in men > 50 years of age .  Population -based screening of men aged between 55 and 69 years , using prostate-specific antigen ( PSA ) testing , has been evaluated in r and omised trials [ 1 , 2 ] . After a median follow-up of 13 years , the European screening trial demonstrated a relative reduction in the risk of prostate cancer mortality of 21 % ( 29 % if adjusted for non-compliance ) . However , 781 men needed to be invited for screening and 27 patients needed to be treated to prevent one death  from prostate cancer . Risk-adapted early detection of prostate cancer using a baseline PSA level has also been evaluated in retrospective cohort studies . The baseline PSA at or before the age of 50 years is associated with the risk of prostate cancer mortality over the subsequent 25 years [ 3 ] Mixed treatment comparison ( MTC ) meta- analysis is a generalization of st and ard pairwise meta- analysis for A vs B trials , to data structures that include , for example , A vs B , B vs C , and A vs C trials . There are two roles for MTC : one is to strengthen inference concerning the relative efficacy of two treatments , by including both ' direct ' and ' indirect ' comparisons . The other is to facilitate simultaneous inference regarding all treatments , in order for example to select the best treatment . In this paper , we present a range of Bayesian hierarchical models using the Markov chain Monte Carlo software WinBUGS . These are multivariate r and om effects models that allow for variation in true treatment effects across trials . We consider models where the between-trials variance is homogeneous across treatment comparisons as well as heterogeneous variance models . We also compare models with fixed ( unconstrained ) baseline study effects with models with r and om baselines drawn from a common distribution . These models are applied to an illustrative data set and posterior parameter distributions are compared . We discuss model critique and model selection , illustrating the role of Bayesian deviance analysis , and node-based model criticism . The assumptions underlying the MTC models and their parameterization are also discussed Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more This r and omized , noncomparative , multicenter , clinical trial evaluated ixabepilone or mitoxantrone/prednisone ( MP ) as second‐line chemotherapy for taxane‐refractory , hormone‐refractory , prostate cancer ( HRPC ) Purpose : To evaluate the efficacy , safety , biomarkers , and pharmacokinetics of rilotumumab , a fully human , monoclonal antibody against hepatocyte growth factor (HGF)/scatter factor , combined with mitoxantrone and prednisone ( MP ) in patients with castration-resistant prostate cancer ( CRPC ) . Experimental Design : This double-blinded phase II study r and omized ( 1:1:1 ) patients with progressive , taxane-refractory CRPC to receive MP ( 12 mg/m2 i.v . day 1 , 5 mg twice a day orally days 1–21 , respectively ) plus 15 mg/kg rilotumumab , 7.5 mg/kg rilotumumab , or placebo ( i.v . day 1 ) every 3 weeks . The primary endpoint was overall survival ( OS ) . Results : One hundred and forty-four patients were r and omized .  Median OS was 12.2 versus 11.1 months [ HR , 1.10 ; 80 % confidence interval ( CI ) , 0.82–1.48 ] in the combined rilotumumab versus control arms . Median progression-free survival was 3.0 versus 2.9 months ( HR , 1.02 ; 80 % CI , 0.79–1.31 ) . Treatment appeared well tolerated with peripheral edema ( 24 % vs. 8 % ) being more common with rilotumumab . A trend toward unfavorable OS was observed in patients with high tumor MET expression regardless of treatment . Soluble MET levels increased in all treatment arms . Total HGF levels increased in the rilotumumab arms . Rilotumumab showed linear pharmacokinetics when co-administered with MP . Conclusions : Rilotumumab plus MP had manageable toxicities and showed no efficacy improvements in this estimation study . High tumor MET expression may identify patients with CRPC with poorer prognosis . Clin Cancer Res ; 19(1 ) ; 215–24 . © 2012 AACR BACKGROUND Mitoxantrone plus prednisone reduces pain and improves the quality of life in men with advanced , hormone-refractory prostate cancer , but it does not improve survival . We compared such treatment with docetaxel plus prednisone in men with this disease . METHODS From March 2000 through June 2002 , 1006 men with metastatic hormone-refractory prostate cancer received 5 mg of prednisone twice daily  and were r and omly assigned to receive 12 mg of mitoxantrone per square meter of body-surface area every three weeks , 75 mg of docetaxel per square meter every three weeks , or 30 mg of docetaxel per square meter weekly for five of every six weeks . The primary end point was overall survival . Secondary end points were pain , prostate-specific antigen ( PSA ) levels , and the quality of life . All statistical comparisons were against mitoxantrone . RESULTS As compared with the men in the mitoxantrone group , men in the group given docetaxel every three weeks had a hazard ratio for death of 0.76 ( 95 percent confidence interval , 0.62 to 0.94 ; P=0.009 by the stratified log-rank test ) and those given weekly docetaxel had a hazard ratio for death of 0.91 ( 95 percent confidence interval , 0.75 to 1.11 ; P=0.36 ) . The median survival was 16.5 months in the mitoxantrone group , 18.9 months in the group given docetaxel every 3 weeks , and 17.4 months in the group given weekly docetaxel . Among these three groups , 32 percent , 45 percent , and 48 percent of men , respectively , had at least a 50 percent decrease in the serum PSA level ( P<0.001 for both comparisons with mitoxantrone ) ; 22 percent , 35 percent ( P=0.01 ) , and 31 percent ( P=0.08 ) had predefined reductions in pain ; and 13 percent , 22 percent ( P=0.009 ) , and 23 percent ( P=0.005 ) had improvements in the quality of life . Adverse events were also more common in the groups that received docetaxel . CONCLUSIONS When given with prednisone , treatment with docetaxel every three weeks led to superior survival and improved rates of response in terms of pain , serum PSA level , and quality of life , as compared with mitoxantrone plus prednisone The st and ard approach for documenting symptomatic adverse events ( AEs ) in cancer clinical trials involves investigator reporting using the National Cancer Institute 's ( NCI 's ) Common Terminology Criteria for Adverse Events ( CTCAE ) . Because this approach underdetects symptomatic AEs , the NCI issued two contracts to create a patient-reported outcome ( PRO ) measurement system as a companion to the CTCAE , called the PRO-CTCAE . This Commentary describes development of the PRO-CTCAE by a group of multidisciplinary investigators and patient representatives and provides an overview of qualitative and quantitative studies of its measurement properties . A systematic evaluation of all 790 AEs listed in the CTCAE identified 78 appropriate for patient self-reporting . For each of these , a PRO-CTCAE plain language term in English and one to three items characterizing the frequency , severity , and /or activity interference of the AE were created , rendering a library of 124 PRO-CTCAE items . These items were refined in a cognitive interviewing study among patients on active cancer treatment with diverse educational , racial , and geographic background s. Favorable measurement properties of the items , including construct validity , reliability , responsiveness , and between-mode equivalence , were determined prospect ively in a demographically diverse population of patients receiving treatments for many different tumor types . A software platform was built to administer PRO-CTCAE items to clinical trial participants via the internet or telephone 
    Output:
    
Conclusions : Our results demonstrated that Abiraterone Acetate might be the optimal intervention for CRPC patients after docetaxel failure with acceptable tolerability .