Treatment for Early Prostate 
Cancer - Reducing Side Effects 
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:FEJ@;<I K?< <==<:K F= 8EP FK?<I =8:KFI K?8E K?< FE< @E:CL;<; 8E; @J K?LJ :8CC<; 
LE8;ALJK<; 8E8CPJ@J N?@C< DLCK@M8I@89C< 8E8CPJ@J @J :8CC<; 8;ALJK<; 8E8CPJ@J &E 
K?< GI<J<E:< F= :FE=FLE;@E>	 <JK@D8K<J @E 8;ALJK<; 8E8CPJ@J ;@==<I =IFD K?< 
<JK@D8K<J @E LE8;ALJK<; 8E8CPJ@J 
!<G<E;@E> FE K?< E8KLI< F= K?< FLK:FD<	 ;@==<I<EK KPG<J F= I<>I<JJ@FE 98J<; 
FE ;@==<I<EK D8K?<D8K@: DF;<CJ 8I< LJ<; =FI 9@E8IP FLK:FD<J	 :FDDFE @E 
<G@;<D@FCF>@: JKL;@<J	 binary &ogistic regression :8E 9< LJ<; %<I<	 K?< <==<:K 
F= FE< FI DFI< M8I@89C<J FE 8E FLK:FD< K?8K :8E <@K?<I F::LI FI EFK	 @J 
<JK@D8K<; K?< FECP @E=FID8K@FE I<>8I;@E> K?< FLK:FD< @J N?<K?<I @K ?8J 
F::LII<; FI EFK &E CF>@JK@: I<>I<JJ@FE	 N< KPG@:8CCP JKL;P 8E FLK:FD< K?8K 
F::LIJ 8K 8 :<IK8@E GF@EK FI N@K?@E 8 JD8CC K@D<=I8D< 4< :FLC; =FI <O8DGC< 
JKL;P K?< <==<:K F= HL@KK@E> JDFB@E> 9<=FI< JLI><IP FE K?< I@JB 8 ?8M@E> 8 
NFLE; @E=<:K@FE #FI <M<EKJ K?8K D@>?K F::LI N@K?@E 8 C8I><I K@D< =I8D<	 JL:? 
8J DFIK8C@KP @E D<K8JK8K@: GIFJK8K< :8E:<I	 K?@J 8GGIF8:? <EK8@CJ JFD< 
C@D@K8K@FEJ 4@K? CFE> <EFL>? =FCCFN
LG	 8CC G8K@<EKJ N@CC <M<EKL8CCP ;@<	 <@K?<I 
=IFD GIFJK8K< :8E:<I FI =IFD FK?<I :8LJ<J &= N< JKL;P K?< <==<:K F= 8 E<N ;IL>	 
@K D@>?K GIFCFE> K@D< KF ;<8K?	 9LK EFK GI<M<EK ;<8K? =IFD GIFJK8K< :8E:<I &= 
N< ALJK :FDG8I< K?< I8K< F= ;<8K? =IFD GIFJK8K< :8E:<I 9<KN<<E G8K@<EKJ 
I<:<@M@E> K?< E<N ;IL> FI EFK	 K?<I< D@>?K 9< EF ;@==<I<E:<J	 ;<JG@K< G8K@<EKJ 
I<:<@M@E> K?< JKL;P ;IL> C@M@E> CFE><I @E 8;;@K@FE	 LEC<JJ K?< JKL;P :FEK@EL<J 
LEK@C <M<IP G8K@<EK ?8J ;@<;	 @E=FID8K@FE =IFD G8K@<EKJ JK@CC 8C@M< 8K K?< <E; F= 
JKL;P N@CC 9< CFJK 1F FM<I:FD< K?@J	 FK?<I D<K?F;J :8E 9< LJ<;	 =FI <O8DGC< 
Co1 regression %<I<	 K?< @E=FID8K@FE :FCC<:K<; I<>8I;@E> K?< FLK:FD< @J EFK 
FECP N?<K?<I @K ?8J F::LII<; FI EFK	 9LK 8CJF N?<E @K ?8J F::LII<; @E I<C8K@FE 
KF N?<E K?< G8K@<EK <EK<I<; K?< JKL;P #FI <M<IP @E:CL;<; @E;@M@;L8C	 K?< 
JKL;@<; K@D< @J :8C:LC8K<; 8E; LJ<; @E K?< 8E8CPJ@J EF @E=FID8K@FE N@CC 9< CFJK 
1?< JK8IK@E> GF@EK @J K?< J8D< =FI <8:? @E;@M@;L8C	 K?FL>? @E:CLJ@FE @E K?< JKL;P 
:8E 9< FE ;@==<I<EK ;8K<J	 N?@C< K?< <E; GF@EK ;@==<IJ #FI @E;@M@;L8CJ 
<OG<I@<E:@E> K?< JKL;@<; <M<EK	 K?< <M<EK @KJ<C= D8IBJ K?< <E; F= K?< JKL;@<; 
K@D< =FI @E;@M@;L8CJ EFK <OG<I@<E:@E> K?< <M<EK	 K?<@I JKL;@<; K@D< <E;J N?<E 
K?< JKL;P <E;J	 FI N?<E K?<P C<8M< =FI JFD< FK?<I I<8JFE 1?@J @J :8CC<; K?< 
:<EJFI@E> GF@EK	 8E; :8J<J 8I< J8@; KF 9< :<EJFI<; 1?< C<E>K? F= JKL;@<; K@D<	 
8E; @= K?< <M<EK ?8J F::LII<; FI EFK	 =FIDJ K?< 98J@J =FI K?< 8E8CPJ@J K?< 
<JK@D8K< F= K?< <==<:K ;F<J K?LJ K8B< K@D< 8J N<CC 8J K?< <M<EK @KJ<C= @EKF 8::FLEK 
 <EJFI@E> @J JLGGFJ<; KF 9< @E;<G<E;<EK	 D<8E@E> K?8K :<EJFI@E> 8E; K?< I@JB 
F= <OG<I@<E:@E> K?< <M<EK 8I< EFK I<C8K<; @E;@M@;L8CJ C<8M@E> K?< JKL;P 8I< 
JLGGFJ<; KF ?8M< K?< J8D< I@JB =FI <OG<I@<E:@E> K?< <M<EK 8J K?< I<D8@E@E> 
@E;@M@;L8CJ EFK?<I 8JJLDGK@FE @E  FO I<>I<JJ@FE @J K?< GIFGFIK@FE8C ?8Q8I;J 
8JJLDGK@FE	 D<8E@E> K?8K K?< I8K@F 9<KN<<E K?< ?8Q8I;J =FI <OG<I@<E:@E> K?< 
#8+':3+4: ,58 +'82? 6859:':+ )'4)+8 E 8+*;)/4- 9/*+ +,,+):9 =/:.5;: 0+56'8*/@/4- );8+ 
	 
G8IK =IFD :8LJ@E> :FE=LJ@FE F= :8LJ<J	 :FE=FLE;@E> :FLC; 8CJF ;@CLK< 8E 
<==<:K JF @K J<<DJ C<JJ 8GG8I<EK	 FI <M<E D8B< @K J<<D I<M<IJ< &= :FE=FLE;<IJ 
8I< EFK ?8E;C<; @E FE< N8P FI 8EFK?<I	 K?< <==<:K D<8JLI< N@CC EFK J?FN K?< 
KIL< <==<:K &;<8CCP	 8CC GFJJ@9C< :FE=FLE;<IJ :8E 9< @;<EK@=@<; 8E; D<8JLI<;	 
9LK JFD<K@D<J N?8K N< :8E D<8JLI< @J FECP 8 GIFOP F= K?< KIL< :FE=FLE;@E> 
<==<:K K?<I< @J 8CJF K?< GFJJ@9@C@KP =FI ;@==<I<EK	 :FDGC<K<CP LEBEFNE 
:FE=FLE;<IJ #FI BEFNE :FE=FLE;<IJ	 K?<I< 8I< J<M<I8C ;@==<I<EK N8PJ F= 
?8E;C@E> K?<D 
 	 
,E< N8P KF :FEKIFC =FI 8 BEFNE :FE=FLE;<I @J KF <O:CL;< G8K@<EKJ N@K? 8 :<IK8@E 
I@JB =8:KFI =IFD K?< JKL;P 1?FL>? I<JKI@:K@FE @J M<IP <==<:K@M< @E I<DFM@E> 8 
:FE=FLE;@E> <==<:K	 @K C@D@KJ K?< JKL;P GFGLC8K@FE	 GFK<EK@8CCP C<8;@E> KF CFJJ F= 
JK8K@JK@:8C GFN<I P I<JKI@:K@FE	 K?< ><E<I8C@Q89@C@KP F= K?< I<JLCKJ N@CC 8CJF 9< 
;@D@E@J?<; &=	 =FI <O8DGC< 8><	 @J 8 JKIFE> :FE=FLE;<I =FI 8E FLK:FD<	 8E; 
G8K@<EKJ FC;<I K?8E 8 :<IK8@E 8>< K?<I<=FI< 8I< <O:CL;<;	 K?< <==<:K F= K?< 
<OGFJLI< FE PFLE><I G8K@<EKJ :8E EFK 8LKFD8K@:8CCP 9< K8B<E =FI >I8EK<; @E 
<C;<I G8K@<EKJ /<JKI@:K@FE @J 8GGC@<; GI@FI KF 8E8CPJ@J &E K?< 8E8CPJ@J K?<I< 8I< 
FK?<I N8PJ F= :FEKIFCC@E> =FI :FE=FLE;<IJ JFD< :FDDFE D<K?F;J N@CC 9< 
GI<J<EK<; 9<CFN 
 	 
&E 8 JKI8K@=@<; 8E8CPJ@J	 K?< D8K<I@8C @J JGC@K @EKF >IFLGJ	 JKI8K8	 98J<; FE K?< 
M8CL< F= K?< JKI8K@=@:8K@FE M8I@89C< 8E; K?< <==<:K D<8JLI< @J :8C:LC8K<; 
J<G8I8K<CP =FI <8:? >IFLG 1?< 8E8CPJ@J F= 9@IK? FI;<I	 D8K<IE8C 8>< 8E; K?< I@JB 
=FI !FNE JPE;IFD< @J 8E <O8DGC< F= JKI8K@=@:8K@FE	 N?<I< K?< I@JB 8::FI;@E> 
KF 9@IK? FI;<I N8J :8C:LC8K<; J<G8I8K<CP =FI :?@C;I<E 98J<; FE D8K<IE8C 8>< &E 
K?@J :8J<	 K?< <==<:K F= 9@IK? FI;<I N8J K?< J8D< @E <M<IP JKI8KLD	 J?FN@E> K?8K 
@K ?8; EF <==<:K FE K?< I@JB &= K?< <==<:K ;@==<IJ 9<KN<<E JKI8K8	 K?<I< @J 8 
:FE=FLE;@E> <==<:K 0KI8K@=@:8K@FE @J FECP GFJJ@9C< N?<E K?<I< 8I< =<N GFJJ@9C< 
:FE=FLE;<IJ 8E; JL==@:@<EK ELD9<I F= :8J<J	 FK?<IN@J< K?< ELD9<I F= >IFLGJ 
N@CC 9< C8I><	 8E; K?< ELD9<I F= :8J<J @E <8:? >IFLG KFF CFN =FI 8E8CPJ@J 
 
 
4?<E K?<I< 8I< D8EP :FE=FLE;<IJ KF :FEJ@;<I	 FK?<I D<K?F;J 8I< E<<;<; &E 
I<>I<JJ@FE 8E8CPJ@J	 8 JK8K@JK@:8C DF;<C =FI K?< I<C8K@FEJ?@G 9<KN<<E FE< 
M8I@89C<	 FI 8 ELD9<I F= M8I@89C<J 8E; K?< FLK:FD< @J =FID<; E8D<; 
LE@M8I@89C< 8E; DLCK@M8I@89C< 8E8CPJ@J	 I<JG<:K@M<CP &E LE@M8I@89C< 8E8CPJ@J	 
K?< <==<:K F= FE< M8I@89C< FE K?< FLK:FD< @J <JK@D8K<; 4?<E 8;;@E> DFI< 
M8I@89C<J @E 8 DLCK@M8I@89C< DF;<C	 K?< <==<:K F= FE< 8E; <8:? F= K?< FK?<I 
M8I@89C<J 8I< @E:FIGFI8K<; @E K?< DF;<C	 GIFM@;@E> 8E <JK@D8K< F= K?< <==<:K FE 
2/4 >A4 
	 
K?< FLK:FD<	 8CC M8I@89C<J :FEJ@;<I<; 8 J<G8I8K< <==<:K D<8JLI< @J GIFM@;<; =FI 
<8:? F= K?< @E:CL;<; M8I@89C<J "JK@D8K<J @E LE@M8I@89C< 8E8CPJ@J ;F<J EFK 
:FEJ@;<I K?< <==<:K F= 8EP FK?<I =8:KFI K?8E K?< FE< @E:CL;<; 8E; @J K?LJ :8CC<; 
LE8;ALJK<; 8E8CPJ@J N?@C< DLCK@M8I@89C< 8E8CPJ@J @J :8CC<; 8;ALJK<; 8E8CPJ@J &E 
K?< GI<J<E:< F= :FE=FLE;@E>	 <JK@D8K<J @E 8;ALJK<; 8E8CPJ@J ;@==<I =IFD K?< 
<JK@D8K<J @E LE8;ALJK<; 8E8CPJ@J 
!<G<E;@E> FE K?< E8KLI< F= K?< FLK:FD<	 ;@==<I<EK KPG<J F= I<>I<JJ@FE 98J<; 
FE ;@==<I<EK D8K?<D8K@: DF;<CJ 8I< LJ<; =FI 9@E8IP FLK:FD<J	 :FDDFE @E 
<G@;<D@FCF>@: JKL;@<J	 binary &ogistic regression :8E 9< LJ<; %<I<	 K?< <==<:K 
F= FE< FI DFI< M8I@89C<J FE 8E FLK:FD< K?8K :8E <@K?<I F::LI FI EFK	 @J 
<JK@D8K<; K?< FECP @E=FID8K@FE I<>8I;@E> K?< FLK:FD< @J N?<K?<I @K ?8J 
F::LII<; FI EFK &E CF>@JK@: I<>I<JJ@FE	 N< KPG@:8CCP JKL;P 8E FLK:FD< K?8K 
F::LIJ 8K 8 :<IK8@E GF@EK FI N@K?@E 8 JD8CC K@D<=I8D< 4< :FLC; =FI <O8DGC< 
JKL;P K?< <==<:K F= HL@KK@E> JDFB@E> 9<=FI< JLI><IP FE K?< I@JB 8 ?8M@E> 8 
NFLE; @E=<:K@FE #FI <M<EKJ K?8K D@>?K F::LI N@K?@E 8 C8I><I K@D< =I8D<	 JL:? 
8J DFIK8C@KP @E D<K8JK8K@: GIFJK8K< :8E:<I	 K?@J 8GGIF8:? <EK8@CJ JFD< 
C@D@K8K@FEJ 4@K? CFE> <EFL>? =FCCFN
LG	 8CC G8K@<EKJ N@CC <M<EKL8CCP ;@<	 <@K?<I 
=IFD GIFJK8K< :8E:<I FI =IFD FK?<I :8LJ<J &= N< JKL;P K?< <==<:K F= 8 E<N ;IL>	 
@K D@>?K GIFCFE> K@D< KF ;<8K?	 9LK EFK GI<M<EK ;<8K? =IFD GIFJK8K< :8E:<I &= 
N< ALJK :FDG8I< K?< I8K< F= ;<8K? =IFD GIFJK8K< :8E:<I 9<KN<<E G8K@<EKJ 
I<:<@M@E> K?< E<N ;IL> FI EFK	 K?<I< D@>?K 9< EF ;@==<I<E:<J	 ;<JG@K< G8K@<EKJ 
I<:<@M@E> K?< JKL;P ;IL> C@M@E> CFE><I @E 8;;@K@FE	 LEC<JJ K?< JKL;P :FEK@EL<J 
LEK@C <M<IP G8K@<EK ?8J ;@<;	 @E=FID8K@FE =IFD G8K@<EKJ JK@CC 8C@M< 8K K?< <E; F= 
JKL;P N@CC 9< CFJK 1F FM<I:FD< K?@J	 FK?<I D<K?F;J :8E 9< LJ<;	 =FI <O8DGC< 
Co1 regression %<I<	 K?< @E=FID8K@FE :FCC<:K<; I<>8I;@E> K?< FLK:FD< @J EFK 
FECP N?<K?<I @K ?8J F::LII<; FI EFK	 9LK 8CJF N?<E @K ?8J F::LII<; @E I<C8K@FE 
KF N?<E K?< G8K@<EK <EK<I<; K?< JKL;P #FI <M<IP @E:CL;<; @E;@M@;L8C	 K?< 
JKL;@<; K@D< @J :8C:LC8K<; 8E; LJ<; @E K?< 8E8CPJ@J EF @E=FID8K@FE N@CC 9< CFJK 
1?< JK8IK@E> GF@EK @J K?< J8D< =FI <8:? @E;@M@;L8C	 K?FL>? @E:CLJ@FE @E K?< JKL;P 
:8E 9< FE ;@==<I<EK ;8K<J	 N?@C< K?< <E; GF@EK ;@==<IJ #FI @E;@M@;L8CJ 
<OG<I@<E:@E> K?< JKL;@<; <M<EK	 K?< <M<EK @KJ<C= D8IBJ K?< <E; F= K?< JKL;@<; 
K@D< =FI @E;@M@;L8CJ EFK <OG<I@<E:@E> K?< <M<EK	 K?<@I JKL;@<; K@D< <E;J N?<E 
K?< JKL;P <E;J	 FI N?<E K?<P C<8M< =FI JFD< FK?<I I<8JFE 1?@J @J :8CC<; K?< 
:<EJFI@E> GF@EK	 8E; :8J<J 8I< J8@; KF 9< :<EJFI<; 1?< C<E>K? F= JKL;@<; K@D<	 
8E; @= K?< <M<EK ?8J F::LII<; FI EFK	 =FIDJ K?< 98J@J =FI K?< 8E8CPJ@J K?< 
<JK@D8K< F= K?< <==<:K ;F<J K?LJ K8B< K@D< 8J N<CC 8J K?< <M<EK @KJ<C= @EKF 8::FLEK 
 <EJFI@E> @J JLGGFJ<; KF 9< @E;<G<E;<EK	 D<8E@E> K?8K :<EJFI@E> 8E; K?< I@JB 
F= <OG<I@<E:@E> K?< <M<EK 8I< EFK I<C8K<; @E;@M@;L8CJ C<8M@E> K?< JKL;P 8I< 
JLGGFJ<; KF ?8M< K?< J8D< I@JB =FI <OG<I@<E:@E> K?< <M<EK 8J K?< I<D8@E@E> 
@E;@M@;L8CJ EFK?<I 8JJLDGK@FE @E  FO I<>I<JJ@FE @J K?< GIFGFIK@FE8C ?8Q8I;J 
8JJLDGK@FE	 D<8E@E> K?8K K?< I8K@F 9<KN<<E K?< ?8Q8I;J =FI <OG<I@<E:@E> K?< 
#8+':3+4: ,58 +'82? 6859:':+ )'4)+8 E 8+*;)/4- 9/*+ +,,+):9 =/:.5;: 0+56'8*/@/4- );8+ 
	 
FLK:FD< =FI 8EP G8@I F= @E:CL;<; @E;@M@;L8CJ J?FLC; 9< :FEJK8EK FM<I K@D< @= 
K?< ?8Q8I; 8K ;@==<I<EK K@D< GF@EKJ J?FLC; 9< GCFKK<; =FI 9FK?	 K?< :LIM<J J?FLC; 
?8M< K?< J8D< I<C8K@FE KF <8:? FK?<I 8K <M<IP GF@EK ,K?<I M8I@89C<J :8E 9< 
@E:CL;<; @E K?< FO DF;<C	 ALJK 8J @E CF>@JK@: I<>I<JJ@FE	 KF GIFM@;< 8E 8;ALJK<; 
<==<:K D<8JLI< "JK@D8K<J F9K8@E<; @E I<>I<JJ@FE 8E8CPJ@J @J LJL8CCP <OGI<JJ<; 
8J 8 I8K@F 9<KN<<E K?< <==<:KJ @E <OGFJ<; 8E; LE<OGFJ<; @E;@M@;L8CJ 
1.. RAOIATIO 
1?< 8@D F= 8;ALJKD<EK @J KF GIFM@;< 8E <==<:K D<8JLI< K?8K @J LE9@8J<;	 D<8E@E> 
D@IIFI@E> FECP K?< <==<:K F= FLI <OGFJLI<	 @= K?<I< N<I< EF :FE=FLE;@E> =8:KFIJ 
*<K?F;J =FI JK8K@JK@:8C 8;ALJKD<EK ;F K?@J 9P GIF;L:@E> 8E 8IK@=@:@8C J@KL8K@FE	 
N?<I< C<M<CJ F= :FE=FLE;<IJ 8I< K?< J8D<	 98C8E:<;	 9<KN<<E <OGFJ<; 8E; 
LE<OGFJ<; >IFLGJ ;ALJKD<EK :8E FECP 9< ;FE< =FI BEFNE :FE=FLE;<IJ FE 
N?@:? N< ?8M< @E=FID8K@FE K?LJ	 K?< <==<:K F= 8EP LEBEFNE FI LED<8JLI<; 
:FE=FLE;<IJ N@CC I<D8@E 
/8E;FD@Q8K@FE @J 8 N8P KF 8:?@<M< 98C8E:< 9<KN<<E >IFLGJ	 9P I8E;FDCP 
8JJ@>E@E> @E;@M@;L8CJ KF <OGFJLI< FI EFK "M<IP @E:CL;<; @E;@M@;L8C K?LJ ?8J 
K?< J8D< GIF989@C@KP F= 9<@E> <OGFJ<;	 @E;<G<E;<EK =IFD 8EP FK?<I =8:KFI	 
@E:CL;@E> LEBEFNE :FE=FLE;<IJ	 @= JL:? <O@JK /8E;FD@Q8K@FE @J KPG@:8CCP ;FE< 
@E KI@8CJ F= E<N ;IL>J	 9LK :8E 8CJF 9< LJ<; @E FK?<I J@KL8K@FEJ	 JL:? 8J K?< 
$WK<9FI> /8E;FD@J<; -IFJK8K<  8E:<I 0:I<<E@E> 1I@8C I<=<II<; KF 89FM< 
/8E;FD@Q8K@FE F=K<E I<HL@I<J 8 CFK F= I<JFLI:<J	 N?@:? @J FE< F= K?< =8:KFIJ 
C@D@K@E> @KJ LJ< 1?<I< 8I< 8CJF J@KL8K@FEJ N?<I< I8E;FD@Q8K@FE @J ?8I; KF 
8:?@<M< @E 8 ;IL> JKL;P	 GC8:<9F D<;@:8K@FE K?8K @J @;<EK@:8C KF K?< JKL;P 
D<;@:8K@FE	 <O:<GK =FI EFK :FEK8@E@E> 8EP 8:K@M< JL9JK8E:<	 :FLC; 9< GIF:LI<; 
0LI>@:8C JKL;@<J 8I< ?8I; KF JK8E;8I;@Q< @E K?< J8D< N8P JLI><I@<J 8I< :FDGC<O 
GIF:<;LI<J N?<I< FLK:FD< ;<G<E;J EFK FECP FE N?8K GIF:<;LI< @J G<I=FID<;	 
9LK 8CJF FE ?FN 8E; 9P N?FD @K @J G<I=FID<; +P9<I> <K 8C 

 
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