Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 ballot
Evidence Based Medicine on FHIR Implementation Guide
1.0.0-ballot3 - STU 1 ballot
Evidence Based Medicine on FHIR Implementation Guide, published by HL7 International / Clinical Decision Support. This guide is not an authorized publication; it is the continuous build for version 1.0.0-ballot3 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/ebm/ and changes regularly. See the Directory of published versions
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"div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\" xml:lang=\"en\" lang=\"en\"><p class=\"res-header-id\"><b>Generated Narrative: Citation 179627</b></p><a name=\"179627\"> </a><a name=\"hc179627\"> </a><div style=\"display: inline-block; background-color: #d9e0e7; padding: 6px; margin: 4px; border: 1px solid #8da1b4; border-radius: 5px; line-height: 60%\"><p style=\"margin-bottom: 0px\">version: 21; Last updated: 2025-10-13 12:34:35+0000; Language: en</p><p style=\"margin-bottom: 0px\">Profile: <a href=\"StructureDefinition-journal-article-citation.html\">JournalArticleCitation</a></p></div><p><b>ArtifactPublicationStatus</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-status-type active}\">Active</span></p><p><b>url</b>: <a href=\"https://fevir.net/resources/Citation/179627\">https://fevir.net/resources/Citation/179627</a></p><p><b>identifier</b>: FEvIR Object Identifier/179627, <code>https://pubmed.ncbi.nlm.nih.gov</code>/19091394</p><p><b>title</b>: 19091394 Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial.</p><p><b>status</b>: Active</p><p><b>author</b>: Computable Publishing®: MEDLINE-to-FEvIR Converter: </p><p><b>publisher</b>: Computable Publishing LLC</p><p><b>contact</b>: <a href=\"mailto:support@computablepublishing.com\">support@computablepublishing.com</a></p><p><b>description</b>: </p><div><p>This Citation Resource is referenced in an example for the EBMonFHIR Implementation Guide.</p>\n</div><h3>UseContexts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Code</b></td><td><b>Value[x]</b></td></tr><tr><td style=\"display: none\">*</td><td><a href=\"http://terminology.hl7.org/7.1.0/CodeSystem-citation-classification-type.html#citation-classification-type-fevir-platform-use\">Citation Classification Type: fevir-platform-use</a> (FEvIR Platform Use)</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/citation-artifact-classifier medline-base}\">Medline Base</span></td></tr></table><p><b>copyright</b>: </p><div><p>https://creativecommons.org/licenses/by-nc-sa/4.0/</p>\n</div><p><b>approvalDate</b>: 2009-02-05</p><p><b>lastReviewDate</b>: 2022-03-30</p><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/citation-classification-type citation-source}\">Citation Source</span></p><p><b>classifier</b>: <span title=\"Codes:\">MEDLINE</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/citation-classification-type medline-owner}\">MEDLINE Citation Owner</span></p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#owner_value NLM}\">National Library of Medicine, Index Section</span></p></blockquote><p><b>currentState</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type medline-medline}\">Medline Citation Status of Medline</span>, <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-publication-status-ppublish}\">PubMed PublicationStatus of ppublish</span></p><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-entrez}\">PubMed Pubstatus of Entrez</span></p><p><b>period</b>: ?? --> 2008-12-19 09:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-pubmed}\">PubMed Pubstatus of Pubmed</span></p><p><b>period</b>: ?? --> 2008-12-19 09:00:00+0000</p></blockquote><blockquote><p><b>statusDate</b></p><p><b>activity</b>: <span title=\"Codes:{http://hl7.org/fhir/citation-status-type pubmed-pubstatus-medline}\">PubMed Pubstatus of Medline</span></p><p><b>period</b>: ?? --> 2009-02-06 09:00:00+0000</p></blockquote><blockquote><p><b>citedArtifact</b></p><p><b>identifier</b>: <code>https://pubmed.ncbi.nlm.nih.gov</code>/19091394, <code>https://doi.org</code>/10.1016/S0140-6736(08)61815-2, pii/S0140-6736(08)61815-2</p><p><b>relatedIdentifier</b>: ISRCTN01534787</p><h3>Titles</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/title-type primary}\">Primary title</span></td><td><div><p>Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial.</p>\n</div></td></tr></table><h3>Abstracts</h3><table class=\"grid\"><tr><td style=\"display: none\">-</td><td><b>Type</b></td><td><b>Text</b></td></tr><tr><td style=\"display: none\">*</td><td><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-abstract-type primary-human-use}\">Primary human use</span></td><td><div><p><strong>BACKGROUND:</strong> Several studies have shown the efficacy of endocrine therapy in combination with radiotherapy in high-risk prostate cancer. To assess the effect of radiotherapy, we did an open phase III study comparing endocrine therapy with and without local radiotherapy, followed by castration on progression.\n<strong>METHODS:</strong> This randomised trial included men from 47 centres in Norway, Sweden, and Denmark. Between February, 1996, and December, 2002, 875 patients with locally advanced prostate cancer (T3; 78%; PSA<70; N0; M0) were centrally randomly assigned by computer to endocrine treatment alone (3 months of total androgen blockade followed by continuous endocrine treatment using flutamide; 439 patients), or to the same endocrine treatment combined with radiotherapy (436 patients). The primary endpoint was prostate-cancer-specific survival, and analysis was by intention to treat. This study is registered as an international standard randomised controlled trial, number ISRCTN01534787.\n<strong>FINDINGS:</strong> After a median follow-up of 7.6 years, 79 men in the endocrine alone group and 37 men in the endocrine plus radiotherapy group had died of prostate cancer. The cumulative incidence at 10 years for prostate-cancer-specific mortality was 23.9% in the endocrine alone group and 11.9% in the endocrine plus radiotherapy group (difference 12.0%, 95% CI 4.9-19.1%), for a relative risk of 0.44 (0.30-0.66). At 10 years, the cumulative incidence for overall mortality was 39.4% in the endocrine alone group and 29.6% in the endocrine plus radiotherapy group (difference 9.8%, 0.8-18.8%), for a relative risk of 0.68 (0.52-0.89). Cumulative incidence at 10 years for PSA recurrence was substantially higher in men in the endocrine-alone group (74.7%vs 25.9%, p<0.0001; HR 0.16; 0.12-0.20). After 5 years, urinary, rectal, and sexual problems were slightly more frequent in the endocrine plus radiotherapy group.\n<strong>INTERPRETATION:</strong> In patients with locally advanced or high-risk local prostate cancer, addition of local radiotherapy to endocrine treatment halved the 10-year prostate-cancer-specific mortality, and substantially decreased overall mortality with fully acceptable risk of side-effects compared with endocrine treatment alone. In the light of these data, endocrine treatment plus radiotherapy should be the new standard.</p>\n</div></td></tr></table><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Correction In</p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016425}\">Published Erratum</span></p><p><b>citation</b>: </p><div><p>Lancet. 2009 Apr 4;373(9670):1174</p>\n</div></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Has Comment In</p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Lancet. 2009 Jan 24;373(9660):274-6. doi: 10.1016/S0140-6736(08)61816-4.</p>\n</div><p><b>target</b>: <a href=\"https://pubmed.ncbi.nlm.nih.gov/19091392/\">https://pubmed.ncbi.nlm.nih.gov/19091392/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Has Comment In</p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Nat Rev Urol. 2009 May;6(5):250-1. doi: 10.1038/nrurol.2009.56.</p>\n</div><p><b>target</b>: <a href=\"https://pubmed.ncbi.nlm.nih.gov/19424171/\">https://pubmed.ncbi.nlm.nih.gov/19424171/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Has Comment In</p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Ann Intern Med. 2009 Jun 16;150(12):JC6-6. doi: 10.7326/0003-4819-150-12-200906160-02006.</p>\n</div><p><b>target</b>: <a href=\"https://pubmed.ncbi.nlm.nih.gov/19528551/\">https://pubmed.ncbi.nlm.nih.gov/19528551/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Has Comment In</p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Eur Urol. 2009 May;55(5):1240. doi: 10.1016/j.eururo.2009.01.059.</p>\n</div><p><b>target</b>: <a href=\"https://pubmed.ncbi.nlm.nih.gov/19650206/\">https://pubmed.ncbi.nlm.nih.gov/19650206/</a></p></blockquote><blockquote><p><b>relatesTo</b></p><p><b>type</b>: Has Comment In</p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016420}\">Comment</span></p><p><b>citation</b>: </p><div><p>Eur Urol. 2009 May;55(5):1239-40. doi: 10.1016/j.eururo.2009.01.058.</p>\n</div><p><b>target</b>: <a href=\"https://pubmed.ncbi.nlm.nih.gov/19650231/\">https://pubmed.ncbi.nlm.nih.gov/19650231/</a></p></blockquote><blockquote><p><b>publicationForm</b></p><blockquote><p><b>publishedIn</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/published-in-type D020492}\">Periodical</span></p><p><b>identifier</b>: Electronic ISSN Type/1474-547X, ISOAbbreviation/Lancet, ISSN Linking/0140-6736, Medline Title Abbreviation/Lancet, NLM Unique ID/2985213R</p><p><b>title</b>: Lancet (London, England)</p><p><b>publisherLocation</b>: England</p></blockquote><p><b>citedMedium</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-medium internet}\">Internet</span></p><p><b>volume</b>: 373</p><p><b>issue</b>: 9660</p><p><b>articleDate</b>: 2009-01-24</p><p><b>pageString</b>: 301-8</p></blockquote><blockquote><p><b>publicationForm</b></p><p><b>citedMedium</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-medium internet-without-issue}\">Internet without issue</span></p><p><b>articleDate</b>: 2008-12-16</p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/artifact-url-classifier abstract}\">Abstract</span></p><p><b>url</b>: <a href=\"https://pubmed.ncbi.nlm.nih.gov/19091394/\">https://pubmed.ncbi.nlm.nih.gov/19091394/</a></p></blockquote><blockquote><p><b>webLocation</b></p><p><b>classifier</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/artifact-url-classifier doi-based}\">DOI Based</span></p><p><b>url</b>: <a href=\"https://doi.org/10.1016/S0140-6736(08)61815-2\">https://doi.org/10.1016/S0140-6736(08)61815-2</a></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type publishing-model}\">Publishing Model</span></p><p><b>classifier</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/citation-artifact-classifier Print-Electronic}\">Print Electronic</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type chemical}\">Chemical</span></p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D000726}\">Androgen Antagonists</span>, <span title=\"Codes:{https://www.cas.org/support/documentation/chemical-substances 76W6J0943E}, {https://www.nlm.nih.gov/mesh D005485}\">Flutamide</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type mesh-heading}\">MeSH heading</span></p><p><b>artifactAssessment</b>: <a href=\"#hc179627/meshHeading0\">ArtifactAssessment: artifact[x] = this resource</a></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type publication-type}\">Publication type</span></p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D017428}\">Clinical Trial, Phase III</span>, <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016428}\">Journal Article</span>, <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016448}\">Multicenter Study</span>, <span title=\"Codes:{https://www.nlm.nih.gov/mesh D016449}\">Randomized Controlled Trial</span>, <span title=\"Codes:{https://www.nlm.nih.gov/mesh D013485}\">Research Support, Non-U.S. Gov't</span></p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type knowledge-artifact-type}\">Knowledge Artifact Type</span></p><p><b>classifier</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/citation-artifact-classifier D016428}\">Journal Article</span></p><p><b>artifactAssessment</b>: Classifier added by Computable Publishing LLC</p></blockquote><blockquote><p><b>classification</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type citation-subset}\">Citation subset</span></p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/bsd/licensee/elements_descriptions.html#citationsubset IM}\">IM</span></p></blockquote><blockquote><p><b>contributorship</b></p><p><b>complete</b>: true</p><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor0\">Widmark A</a></p><p><b>forenameInitials</b>: A</p><p><b>affiliation</b>: Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden.</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor1\">Klepp O</a></p><p><b>forenameInitials</b>: O</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor2\">Solberg A</a></p><p><b>forenameInitials</b>: A</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor3\">Damber JE</a></p><p><b>forenameInitials</b>: JE</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor4\">Angelsen A</a></p><p><b>forenameInitials</b>: A</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor5\">Fransson P</a></p><p><b>forenameInitials</b>: P</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor6\">Lund JA</a></p><p><b>forenameInitials</b>: JA</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor7\">Tasdemir I</a></p><p><b>forenameInitials</b>: I</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor8\">Hoyer M</a></p><p><b>forenameInitials</b>: M</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor9\">Wiklund F</a></p><p><b>forenameInitials</b>: F</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor10\">Fosså SD</a></p><p><b>forenameInitials</b>: SD</p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor11\">Scandinavian Prostate Cancer Group Study 7</a></p></blockquote><blockquote><p><b>entry</b></p><p><b>contributor</b>: <a href=\"#hc179627/contributor12\">Swedish Association for Urological Oncology 3</a></p></blockquote></blockquote></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor0</b></p><a name=\"179627/contributor0\"> </a><a name=\"hc179627/contributor0\"> </a><p><b>name</b>: Anders Widmark </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor1</b></p><a name=\"179627/contributor1\"> </a><a name=\"hc179627/contributor1\"> </a><p><b>name</b>: Olbjørn Klepp </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor2</b></p><a name=\"179627/contributor2\"> </a><a name=\"hc179627/contributor2\"> </a><p><b>name</b>: Arne Solberg </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor3</b></p><a name=\"179627/contributor3\"> </a><a name=\"hc179627/contributor3\"> </a><p><b>name</b>: Jan-Erik Damber </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor4</b></p><a name=\"179627/contributor4\"> </a><a name=\"hc179627/contributor4\"> </a><p><b>name</b>: Anders Angelsen </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor5</b></p><a name=\"179627/contributor5\"> </a><a name=\"hc179627/contributor5\"> </a><p><b>name</b>: Per Fransson </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor6</b></p><a name=\"179627/contributor6\"> </a><a name=\"hc179627/contributor6\"> </a><p><b>name</b>: Jo-Asmund Lund </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor7</b></p><a name=\"179627/contributor7\"> </a><a name=\"hc179627/contributor7\"> </a><p><b>name</b>: Ilker Tasdemir </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor8</b></p><a name=\"179627/contributor8\"> </a><a name=\"hc179627/contributor8\"> </a><p><b>name</b>: Morten Hoyer </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor9</b></p><a name=\"179627/contributor9\"> </a><a name=\"hc179627/contributor9\"> </a><p><b>name</b>: Fredrik Wiklund </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Practitioner #contributor10</b></p><a name=\"179627/contributor10\"> </a><a name=\"hc179627/contributor10\"> </a><p><b>name</b>: Sophie D Fosså </p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Organization #contributor11</b></p><a name=\"179627/contributor11\"> </a><a name=\"hc179627/contributor11\"> </a><p><b>name</b>: Scandinavian Prostate Cancer Group Study 7</p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: Organization #contributor12</b></p><a name=\"179627/contributor12\"> </a><a name=\"hc179627/contributor12\"> </a><p><b>name</b>: Swedish Association for Urological Oncology 3</p></blockquote><hr/><blockquote><p class=\"res-header-id\"><b>Generated Narrative: ArtifactAssessment #meshHeading0</b></p><a name=\"179627/meshHeading0\"> </a><a name=\"hc179627/meshHeading0\"> </a><p><b>artifact</b>: <a href=\"#hc179627\">Citation 19091394 Endocrine treatment, with or without radiotherapy, in locally advanced prostate cancer (SPCG-7/SFUO-3): an open randomised phase III trial.</a></p><blockquote><p><b>content</b></p><p><b>type</b>: <span title=\"Codes:{http://terminology.hl7.org/CodeSystem/cited-artifact-classification-type mesh-heading}\">components (if present) include qualifier codings</span></p><p><b>classifier</b>: <span title=\"Codes:{https://www.nlm.nih.gov/mesh D000368}\">Aged</span></p><p><b>freeToShare</b>: 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"text" : "**BACKGROUND:** Several studies have shown the efficacy of endocrine therapy in combination with radiotherapy in high-risk prostate cancer. To assess the effect of radiotherapy, we did an open phase III study comparing endocrine therapy with and without local radiotherapy, followed by castration on progression.\n**METHODS:** This randomised trial included men from 47 centres in Norway, Sweden, and Denmark. Between February, 1996, and December, 2002, 875 patients with locally advanced prostate cancer (T3; 78%; PSA<70; N0; M0) were centrally randomly assigned by computer to endocrine treatment alone (3 months of total androgen blockade followed by continuous endocrine treatment using flutamide; 439 patients), or to the same endocrine treatment combined with radiotherapy (436 patients). The primary endpoint was prostate-cancer-specific survival, and analysis was by intention to treat. This study is registered as an international standard randomised controlled trial, number ISRCTN01534787.\n**FINDINGS:** After a median follow-up of 7.6 years, 79 men in the endocrine alone group and 37 men in the endocrine plus radiotherapy group had died of prostate cancer. The cumulative incidence at 10 years for prostate-cancer-specific mortality was 23.9% in the endocrine alone group and 11.9% in the endocrine plus radiotherapy group (difference 12.0%, 95% CI 4.9-19.1%), for a relative risk of 0.44 (0.30-0.66). At 10 years, the cumulative incidence for overall mortality was 39.4% in the endocrine alone group and 29.6% in the endocrine plus radiotherapy group (difference 9.8%, 0.8-18.8%), for a relative risk of 0.68 (0.52-0.89). Cumulative incidence at 10 years for PSA recurrence was substantially higher in men in the endocrine-alone group (74.7%vs 25.9%, p<0.0001; HR 0.16; 0.12-0.20). After 5 years, urinary, rectal, and sexual problems were slightly more frequent in the endocrine plus radiotherapy group.\n**INTERPRETATION:** In patients with locally advanced or high-risk local prostate cancer, addition of local radiotherapy to endocrine treatment halved the 10-year prostate-cancer-specific mortality, and substantially decreased overall mortality with fully acceptable risk of side-effects compared with endocrine treatment alone. In the light of these data, endocrine treatment plus radiotherapy should be the new standard."
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