human
***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 To establish a consensus in relation to case selection , conduct of therapy , and outcomes that are associated with focal therapy for men with localized prostate cancer . MATERIAL AND METHODS Urologic surgeons , radiation oncologists , radiologists , and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer . The consensus process was face to face within a structured meeting , in which pertinent clinical issues were raised , discussed , and agreement sought . Where no agreement was possible , this was acknowledged , and the nature of the disagreement noted . RESULTS C and i date s for focal treatment should have unilateral low- to intermediate-risk disease with clinical stage < or = cT(2a ) . Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used . Currently , the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies . MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results . For general use , however , these new techniques require validation in prospect i ve clinical trials . Until such are performed , MRI will , in most centers , continue to be an investigative tool in assessing eligibility of patients for focal therapy . CONCLUSIONS Consensus was derived for most of the key aspects of case selection , conduct of treatment , and outcome measures for men who are undergoing focal therapy for localized prostate cancer . The level of agreement achieved will pave the way for future collaborative trials BACKGROUND Although there is r and omized evidence that radical prostatectomy improves survival , there are few data on how benefit varies by baseline risk . OBJECTIVE We aim ed to create a statistical model to calculate the decrease in risk of death associated with surgery for an individual patient , using stage , grade , prostate-specific antigen , and age as predictors . DESIGN , SETTING , AND PARTICIPANTS A total of 695 men with T1 or T2 prostate cancer participated in the Sc and inavian Prostate Cancer Group 4 trial ( SPCG-4 ) . INTERVENTION Patients in SPCG-4 were r and omized to radical prostatectomy or conservative management . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing risk models were created separately for the radical prostatectomy and the watchful waiting group , with the difference between model predictions constituting the estimated benefit for an individual patient . RESULTS AND LIMITATIONS Individualized predictions of surgery benefit varied widely depending on age and tumor characteristics . At 65 yr of age , the absolute 10-yr risk reduction in prostate cancer mortality attributable to radical prostatectomy ranged from 4.5 % to 17.2 % for low- versus high-risk patients . Little expected benefit was associated with surgery much beyond age 70 . Only about a quarter of men had an individualized benefit within even 50 % of the mean . A limitation is that estimates from SPCG-4 have to be applied cautiously to contemporary patients . CONCLUSIONS Our model suggests that it is hard to justify surgery in patients with Gleason 6 , T1 disease or in those patients much above 70 yr of age . Conversely , surgery seems unequivocally of benefit for patients who have Gleason 8 , or Gleason 7 , stage T2 . For patients with Gleason 6 T2 and Gleason 7 T1 , treatment is more of a judgment call , depending on patient preference and other clinical findings , such as the number of positive biopsy cores and comorbidities Background To assess the feasibility and early toxicity of selective , IMRT-based dose escalation ( simultaneous integrated boost ) to biopsy proven dominant intra-prostatic lesions visible on MRI . Methods Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible . All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality . Gold fiducial markers were also placed . Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan . This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion . A 3 mm expansion was performed on the intra-prostatic lesions , defined as a separate volume within the prostate . The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray ( Gy ) respectively in 42 fractions . Daily seed position was verified to be within 3 mm . Results Three patients were treated . Follow-up was 18 , 6 , and 3 months respectively . Two patients had a single intra-prostatic lesion . One patient had 2 intra-prostatic lesions . All four intra-prostatic lesions , with margin , were successfully targeted and treated to 94.5 Gy . Two patients experienced acute RTOG grade 2 genitourinary ( GU ) toxicity . One had grade 1 gastrointestinal ( GI ) toxicity . All symptoms completely resolved by 3 months . One patient had no acute toxicity . Conclusion These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI . The treatment was well tolerated Summary Background Radical whole-gl and therapy can lead to significant genitourinary and rectal side-effects for men with localised prostate cancer . We report on whether selective focal ablation of unifocal and multifocal cancer lesions can reduce this treatment burden . Methods Men aged 45–80 years were eligible for this prospect i ve development study if they had low-risk to high-risk localised prostate cancer ( prostate specific antigen [ PSA ] ≤15 ng/mL , Gleason score ≤4 + 3 , stage ≤T2 ) , with no previous and rogen deprivation or treatment for prostate cancer , and who could safely undergo multiparametric MRI and have a general anaesthetic . Patients received focal therapy using high-intensity focused ultrasound , delivered to all known cancer lesions , with a margin of normal tissue , identified on multiparametric MRI , template prostate-mapping biopsies , or both . Primary endpoints were adverse events ( serious and otherwise ) and urinary symptoms and erectile function assessed using patient question naires . Analyses were done on a per- protocol basis . This study is registered with Clinical Trials.gov , number NCT00561314 . Findings 42 men were recruited between June 27 , 2007 , and June 30 , 2010 ; one man died from an unrelated cause ( pneumonia ) 3 months after treatment and was excluded from analyses . After treatment , one man was admitted to hospital for acute urinary retention , and another had stricture interventions requiring hospital admission . Nine men ( 22 % , 95 % CI 11–38 ) had self-resolving , mild to moderate , intermittent dysuria ( median duration 5·0 days [ IQR 2·5–18·5 ] ) . Urinary debris occurred in 14 men ( 34 % , 95 % CI 20–51 ) , with a median duration of 14·5 days ( IQR 6·0–16·5 ) . Urinary tract infection was noted in seven men ( 17 % , 95 % CI 7–32 ) . Median overall International Index of Erectile Function-15 ( IIEF-15 ) scores were similar at baseline and at 12 months ( p=0·060 ) , as were median IIEF-15 scores for intercourse satisfaction ( p=0·454 ) , sexual desire ( p=0·644 ) , and overall satisfaction ( p=0·257 ) . Significant deteriorations between baseline and 12 months were noted for IIEF-15 erectile ( p=0·042 ) and orgasmic function ( p=0·003 ) . Of 35 men with good baseline function , 31 ( 89 % , 95 % CI 73–97 ) had erections sufficient for penetration 12 months after focal therapy . Median UCLA Exp and ed Prostate Cancer Index Composite ( EPIC ) urinary incontinence scores were similar at baseline as and 12 months ( p=0·045 ) . There was an improvement in lower urinary tract symptoms , assessed by International Prostate Symptom Score ( IPSS ) , between baseline and 12 months ( p=0·026 ) , but the IPSS- quality of life score showed no difference between baseline and 12 months ( p=0·655 ) . All 38 men with no baseline urinary incontinence were leak-free and pad-free by 9 months . All 40 men pad-free at baseline were pad-free by 3 months and maintained pad-free continence at 12 months . No significant difference was reported in median Trial Outcomes Index scores between baseline and 12 months ( p=0·113 ) but significant improvement was shown in median Functional Assessment of Cancer Therapy (FACT)-Prostate ( p=0·045 ) and median FACT-General scores ( p=0·041 ) . No histological evidence of cancer was identified in 30 of 39 men biopsied at 6 months ( 77 % , 95 % CI 61–89 ) ; 36 ( 92 % , 79–98 ) were free of clinical ly significant cancer . After retreatment in four men , 39 of 41 ( 95 % , 95 % CI 83–99 ) had no evidence of disease on multiparametric MRI at 12 months . Interpretation Focal therapy of individual prostate cancer lesions , whether multifocal or unifocal , leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinical ly significant prostate cancer . Funding Medical Research Council ( UK ) , Pelican Cancer Foundation , and St Peters Trust Active surveillance followed by selective treatment for men who have evidence of disease progression may be an option for select patients with early‐stage prostate cancer . In this article , the authors report their experience in a contemporary cohort of men with prostate cancer who were managed with active surveillance BACKGROUND In 2008 , we reported that radical prostatectomy , as compared with watchful waiting , reduces the rate of death from prostate cancer . After an additional 3 years of follow-up , we now report estimated 15-year results . METHODS From October 1989 through February 1999 , we r and omly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy .  Follow-up was complete through December 2009 , with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death . Relative risks , with 95 % confidence intervals , were estimated with the use of a Cox proportional-hazards model . RESULTS During a median of 12.8 years , 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died ( P=0.007 ) . In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting , death was due to prostate cancer . This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6 % and 20.7 % , respectively ( a difference of 6.1 percentage points ; 95 % confidence interval [ CI ] , 0.2 to 12.0 ) , and a relative risk with surgery of 0.62 ( 95 % CI , 0.44 to 0.87 ; P=0.01 ) . The survival benefit was similar before and after 9 years of follow-up , was observed also among men with low-risk prostate cancer , and was confined to men younger than 65 years of age . The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age . Among men who underwent radical prostatectomy  , those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth ( relative risk , 6.9 ; 95 % CI , 2.6 to 18.4 ) . CONCLUSIONS Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer . Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment . ( Funded by the Swedish Cancer Society and the National Institutes of Health . ) INTRODUCTION The sub Comittee prostate of the CCAFU established guidelines for diagnostic , treatment , evaluation and st and art of care of prostate cancer . METHODS Guidelines 2010 were up date d based on systematic literature search performed by the sub-Comittee in Medline and PubMed data bases to evaluate references , levels of evidence and grade of recomm and ation . RESULTS Pathological examination of the tissue specimens was defined specifically for Gleason score according to ISP 2005 recomm and ations . Prostate and pelvis RMN became the reference in terms of radiological exam . Individual and early diagnosis of prostate cancer was defined and role of PSA was precised . Active surveillance became one of the st and art of care of low-risk tumors , radical prostatectomy remained one of the options for all risk group tumors , length of hormonotherapy in association with radiotherapy was precised according to the risk group . Side effects of  hormonotherapy  treament needed specific supervision ; hormonotherapy had no indication in case of non metastatic tumors and intermittent hormonotherapy in metastatic tumors . New hormonal drugs in pre and post chemotherapy and bone target drugs opened new therapeutics pathways . CONCLUSION From 2010 to 2013 , st and arts of care of prostate cancer were modified because of results of prospect i ve studies 
    Output:
    
agent
***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 To establish a consensus in relation to case selection , conduct of therapy , and outcomes that are associated with focal therapy for men with localized prostate cancer . MATERIAL AND METHODS Urologic surgeons , radiation oncologists , radiologists , and histopathologists from North America and Europe participated in a consensus workshop on focal therapy for prostate cancer . The consensus process was face to face within a structured meeting , in which pertinent clinical issues were raised , discussed , and agreement sought . Where no agreement was possible , this was acknowledged , and the nature of the disagreement noted . RESULTS C and i date s for focal treatment should have unilateral low- to intermediate-risk disease with clinical stage < or = cT(2a ) . Prostate size and both tumor volume and tumor topography are important case selection criteria that depend on the ablative technology used . Currently , the best method to ascertain the key characteristics for men who are considering focal therapy is exposure to transperineal template mapping biopsies . MRI of the prostate using novel techniques such as dynamic contrast enhancement and diffusion weighed imaging are increasingly being used to diagnose and stage primary prostate cancer with excellent results . For general use , however , these new techniques require validation in prospect i ve clinical trials . Until such are performed , MRI will , in most centers , continue to be an investigative tool in assessing eligibility of patients for focal therapy . CONCLUSIONS Consensus was derived for most of the key aspects of case selection , conduct of treatment , and outcome measures for men who are undergoing focal therapy for localized prostate cancer . The level of agreement achieved will pave the way for future collaborative trials BACKGROUND Although there is r and omized evidence that radical prostatectomy improves survival , there are few data on how benefit varies by baseline risk . OBJECTIVE We aim ed to create a statistical model to calculate the decrease in risk of death associated with surgery for an individual patient , using stage , grade , prostate-specific antigen , and age as predictors . DESIGN , SETTING , AND PARTICIPANTS A total of 695 men with T1 or T2 prostate cancer participated in the Sc and inavian Prostate Cancer Group 4 trial ( SPCG-4 ) . INTERVENTION Patients in SPCG-4 were r and omized to radical prostatectomy or conservative management . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Competing risk models were created separately for the radical prostatectomy and the watchful waiting group , with the difference between model predictions constituting the estimated benefit for an individual patient . RESULTS AND LIMITATIONS Individualized predictions of surgery benefit varied widely depending on age and tumor characteristics . At 65 yr of age , the absolute 10-yr risk reduction in prostate cancer mortality attributable to radical prostatectomy ranged from 4.5 % to 17.2 % for low- versus high-risk patients . Little expected benefit was associated with surgery much beyond age 70 . Only about a quarter of men had an individualized benefit within even 50 % of the mean . A limitation is that estimates from SPCG-4 have to be applied cautiously to contemporary patients . CONCLUSIONS Our model suggests that it is hard to justify surgery in patients with Gleason 6 , T1 disease or in those patients much above 70 yr of age . Conversely , surgery seems unequivocally of benefit for patients who have Gleason 8 , or Gleason 7 , stage T2 . For patients with Gleason 6 T2 and Gleason 7 T1 , treatment is more of a judgment call , depending on patient preference and other clinical findings , such as the number of positive biopsy cores and comorbidities Background To assess the feasibility and early toxicity of selective , IMRT-based dose escalation ( simultaneous integrated boost ) to biopsy proven dominant intra-prostatic lesions visible on MRI . Methods Patients with localized prostate cancer and an abnormality within the prostate on endorectal coil MRI were eligible . All patients underwent a MRI-guided transrectal biopsy at the location of the MRI abnormality . Gold fiducial markers were also placed . Several days later patients underwent another MRI scan for fusion with the treatment planning CT scan . This fused MRI scan was used to delineate the region of the biopsy proven intra-prostatic lesion . A 3 mm expansion was performed on the intra-prostatic lesions , defined as a separate volume within the prostate . The lesion + 3 mm and the remainder of the prostate + 7 mm received 94.5/75.6 Gray ( Gy ) respectively in 42 fractions . Daily seed position was verified to be within 3 mm . Results Three patients were treated . Follow-up was 18 , 6 , and 3 months respectively . Two patients had a single intra-prostatic lesion . One patient had 2 intra-prostatic lesions . All four intra-prostatic lesions , with margin , were successfully targeted and treated to 94.5 Gy . Two patients experienced acute RTOG grade 2 genitourinary ( GU ) toxicity . One had grade 1 gastrointestinal ( GI ) toxicity . All symptoms completely resolved by 3 months . One patient had no acute toxicity . Conclusion These early results demonstrate the feasibility of using IMRT for simultaneous integrated boost to biopsy proven dominant intra-prostatic lesions visible on MRI . The treatment was well tolerated Summary Background Radical whole-gl and therapy can lead to significant genitourinary and rectal side-effects for men with localised prostate cancer . We report on whether selective focal ablation of unifocal and multifocal cancer lesions can reduce this treatment burden . Methods Men aged 45–80 years were eligible for this prospect i ve development study if they had low-risk to high-risk localised prostate cancer ( prostate specific antigen [ PSA ] ≤15 ng/mL , Gleason score ≤4 + 3 , stage ≤T2 ) , with no previous and rogen deprivation or treatment for prostate cancer , and who could safely undergo multiparametric MRI and have a general anaesthetic . Patients received focal therapy using high-intensity focused ultrasound , delivered to all known cancer lesions , with a margin of normal tissue , identified on multiparametric MRI , template prostate-mapping biopsies , or both . Primary endpoints were adverse events ( serious and otherwise ) and urinary symptoms and erectile function assessed using patient question naires . Analyses were done on a per- protocol basis . This study is registered with Clinical Trials.gov , number NCT00561314 . Findings 42 men were recruited between June 27 , 2007 , and June 30 , 2010 ; one man died from an unrelated cause ( pneumonia ) 3 months after treatment and was excluded from analyses . After treatment , one man was admitted to hospital for acute urinary retention , and another had stricture interventions requiring hospital admission . Nine men ( 22 % , 95 % CI 11–38 ) had self-resolving , mild to moderate , intermittent dysuria ( median duration 5·0 days [ IQR 2·5–18·5 ] ) . Urinary debris occurred in 14 men ( 34 % , 95 % CI 20–51 ) , with a median duration of 14·5 days ( IQR 6·0–16·5 ) . Urinary tract infection was noted in seven men ( 17 % , 95 % CI 7–32 ) . Median overall International Index of Erectile Function-15 ( IIEF-15 ) scores were similar at baseline and at 12 months ( p=0·060 ) , as were median IIEF-15 scores for intercourse satisfaction ( p=0·454 ) , sexual desire ( p=0·644 ) , and overall satisfaction ( p=0·257 ) . Significant deteriorations between baseline and 12 months were noted for IIEF-15 erectile ( p=0·042 ) and orgasmic function ( p=0·003 ) . Of 35 men with good baseline function , 31 ( 89 % , 95 % CI 73–97 ) had erections sufficient for penetration 12 months after focal therapy . Median UCLA Exp and ed Prostate Cancer Index Composite ( EPIC ) urinary incontinence scores were similar at baseline as and 12 months ( p=0·045 ) . There was an improvement in lower urinary tract symptoms , assessed by International Prostate Symptom Score ( IPSS ) , between baseline and 12 months ( p=0·026 ) , but the IPSS- quality of life score showed no difference between baseline and 12 months ( p=0·655 ) . All 38 men with no baseline urinary incontinence were leak-free and pad-free by 9 months . All 40 men pad-free at baseline were pad-free by 3 months and maintained pad-free continence at 12 months . No significant difference was reported in median Trial Outcomes Index scores between baseline and 12 months ( p=0·113 ) but significant improvement was shown in median Functional Assessment of Cancer Therapy (FACT)-Prostate ( p=0·045 ) and median FACT-General scores ( p=0·041 ) . No histological evidence of cancer was identified in 30 of 39 men biopsied at 6 months ( 77 % , 95 % CI 61–89 ) ; 36 ( 92 % , 79–98 ) were free of clinical ly significant cancer . After retreatment in four men , 39 of 41 ( 95 % , 95 % CI 83–99 ) had no evidence of disease on multiparametric MRI at 12 months . Interpretation Focal therapy of individual prostate cancer lesions , whether multifocal or unifocal , leads to a low rate of genitourinary side-effects and an encouraging rate of early absence of clinical ly significant prostate cancer . Funding Medical Research Council ( UK ) , Pelican Cancer Foundation , and St Peters Trust Active surveillance followed by selective treatment for men who have evidence of disease progression may be an option for select patients with early‐stage prostate cancer . In this article , the authors report their experience in a contemporary cohort of men with prostate cancer who were managed with active surveillance BACKGROUND In 2008 , we reported that radical prostatectomy , as compared with watchful waiting , reduces the rate of death from prostate cancer . After an additional 3 years of follow-up , we now report estimated 15-year results . METHODS From October 1989 through February 1999 , we r and omly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy .  Follow-up was complete through December 2009 , with histopathological review of biopsy and radical-prostatectomy specimens and blinded evaluation of causes of death . Relative risks , with 95 % confidence intervals , were estimated with the use of a Cox proportional-hazards model . RESULTS During a median of 12.8 years , 166 of the 347 men in the radical-prostatectomy group and 201 of the 348 in the watchful-waiting group died ( P=0.007 ) . In the case of 55 men assigned to surgery and 81 men assigned to watchful waiting , death was due to prostate cancer . This yielded a cumulative incidence of death from prostate cancer at 15 years of 14.6 % and 20.7 % , respectively ( a difference of 6.1 percentage points ; 95 % confidence interval [ CI ] , 0.2 to 12.0 ) , and a relative risk with surgery of 0.62 ( 95 % CI , 0.44 to 0.87 ; P=0.01 ) . The survival benefit was similar before and after 9 years of follow-up , was observed also among men with low-risk prostate cancer , and was confined to men younger than 65 years of age . The number needed to treat to avert one death was 15 overall and 7 for men younger than 65 years of age . Among men who underwent radical prostatectomy  , those with extracapsular tumor growth had a risk of death from prostate cancer that was 7 times that of men without extracapsular tumor growth ( relative risk , 6.9 ; 95 % CI , 2.6 to 18.4 ) . CONCLUSIONS Radical prostatectomy was associated with a reduction in the rate of death from prostate cancer . Men with extracapsular tumor growth may benefit from adjuvant local or systemic treatment . ( Funded by the Swedish Cancer Society and the National Institutes of Health . ) INTRODUCTION The sub Comittee prostate of the CCAFU established guidelines for diagnostic , treatment , evaluation and st and art of care of prostate cancer . METHODS Guidelines 2010 were up date d based on systematic literature search performed by the sub-Comittee in Medline and PubMed data bases to evaluate references , levels of evidence and grade of recomm and ation . RESULTS Pathological examination of the tissue specimens was defined specifically for Gleason score according to ISP 2005 recomm and ations . Prostate and pelvis RMN became the reference in terms of radiological exam . Individual and early diagnosis of prostate cancer was defined and role of PSA was precised . Active surveillance became one of the st and art of care of low-risk tumors , radical prostatectomy remained one of the options for all risk group tumors , length of hormonotherapy in association with radiotherapy was precised according to the risk group . Side effects of  hormonotherapy  treament needed specific supervision ; hormonotherapy had no indication in case of non metastatic tumors and intermittent hormonotherapy in metastatic tumors . New hormonal drugs in pre and post chemotherapy and bone target drugs opened new therapeutics pathways . CONCLUSION From 2010 to 2013 , st and arts of care of prostate cancer were modified because of results of prospect i ve studies 
    Output:
    