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    Erectile dysfunction is a stumbling block for all couples in the world. It troubles partners unexpectedly and ruins their relations. Men become silent and try to avoid spending time in their women’s company. Women start thinking that something is wrong with their appearance and that men cannot erect because they are not attractive anymore. Cialis is a drug that can make men’s intimate relations not so complicated. Tadalafil brings back erection back to the norm and women start feeling pretty and desired again.

    Cialis Can Be Different

    Top 6 Types of Generic Cialis: Which One To Choose?

    It’s a well-known fact that there are two types of drugs according to their origin: brand and generic ones. Many people think that they differ much. They think that only brand-name medicines can produce the best effect and cope with the problem. The truth is that generics are mere analogs. They have the same composition and can treat the same health disorders.

    So, what’s the difference? Why does this distinctive feature make people think that brand-name drugs are better than generics? The matter is in their price. Generics are cheaper but a cheap thing doesn’t always mean a bad thing. The research shows that contemporary pharmaceutical companies spend huge sums on research to have the right to sell solid drugs with an excellent reputation. Generics take the formula and rename the medicine. They economize on international fame but reserve the quality. So, there is no need to pay more to get the desired results.

    Generic variants of Tadalafil are also of high-quality. They differ in strength, shape, and form. There are six main analogs of Cialis.

    Cialis Soft Tabs

    These tablets have a strong effect and improve men’s health. Erectile dysfunction is a delicate problem and it requires a soft solution. Cialis Soft Tabs produce such an effect and help to gain a natural erection.

    Generic Cialis (view prices)

    The generic variant of the brand doesn’t differ from the original. Its price is lower and when buying a blister that contains more than 100 pills, a person can save a solid sum.

    Female Cialis

    This is the only drug variant that can be taken by females. Scientists have found out that women can also lack sexual desire after menopause, childbirth, and surgery. Female Cialis brings back sensitivity of the clitoris. It leads to better lubrication and a woman feels pleasure instead of irritation and burning provoked by the dryness.

    Cialis Black 800 (view prices)

    Cialis Black 800 is not to be taken by males who have first signs of impotence. Only patients who have serious problems with erection and even neglected impotence take Black Cialis. Doctors prescribe these pills to those who also lack libido and stamina. One pill contains 80mg of the active component. It means that they are strong but can cause severe adverse effects in case of improper intake.

    Cialis Professional

    Men with impotence need professional help. Cialis Professional has an improved formula. Their aim is to find the reason, delete it and let a person experience a stable erection that promises satisfaction in bed for both partners.

    Cialis Super Active+

    If a person needs to raise the level of testosterone, improve erection, get rid of premature ejaculation, and experience sexual arousal, then it’s high time to take Cialis Super Active+. Compared to other generic variants, this type starts working in 5-7 minutes. That’s their PLUS.

    Where to Get Pills?

    Online pharmacies can supply people with the generic every man needs. The online drugstore offers high-quality products, discounts, and bonuses for regular customers and quick service to let everyone get the drugs as soon as possible.

    List of verified online pharmacies:


    Canadian Pharmacy is reinventing the way people shop for generic drugs online – the dark days when getting drugs through the web are coming to an end as the neoteric platform steps in. The brand new project of Online Pharmacy, the aspiring aggregator of online pharmacies is gaining momentum at a railway speed – the lineup of generic drugs represented at the platform has increased by 57% in just 5 months, while the number of pharmacy partners has quadrupled since December, 2015. And what is absolutely important – the platform doesn’t sell drugs, it is primarily aiming at gathering trustworthy, licensed online drugstores with a successful track record, practicing fair offers and transparent terms.

    Need to read some more about Generic Drugs? Go to Online Pharmacy for a fill-in:

    The risks associated with counterfeit products are reduced to nothing as the platform initiates an in-depth scanning of high and low level business activities before issuing an approval. From investigations of the origin of drugs to tests of payment methods and delivery methods, once the drugstore is approved to share its offers within the platform, you almost get a guarantee that the quality of both products and customer service will leave nothing to be desired. And this is how these guys pave the way towards success and help millions of people to access quality drugs at a fair price.

    The prices are falling. The quality is the same.

    Getting Cheap & Quality Viagra: The No-Scam ExperienceOnline Pharmacy primarily bets on those online pharmacies who have managed to establish business communications with manufacturers. In aspiration to encourage more competitive terms among its partners and maintain access to cost-effective meds, the local authorities promise to keep the price range at a reasonable level, excluding any risks associated with upsurges. Therefore, the cost of generic Viagra according to the late March, 2016 offers starts from just $2.00 per pill, and even lower for those buying in bulk. That’s approximately 10 times lower in comparison with branded medications. No hidden fees or extra payments. Everything’s fair and transparent. And that’s not the only advantage Canadian Pharmacy boasts: it leaves its brick and mortar competitors in dust in terms of products selection. What can your local pharmacy offer? A couple of dose modifications of Viagra, Cialis and Levitra… and that’s it. At Canadian Pharmacy you can choose from a wealth of dosage, form and even formulations options – Viagra Oral Jelly, 2.5 – 150mg sildenafil citrate pills, multi-component drugs like Viagra Super Active (based on sildenafil citrate and dapoxetine, it helps you effectively deal with premature ejaculation and sexual fatigue)… and that’s just the tip of the iceberg.

    The juicy benefits of staying with Online Pharmacy

    Basically, Canadian Pharmacy is a one way stop for efficient erectile dysfunction treatment – not only you can choose some cheap drugs here. If you are beating your brains about finding an optimal way to recover your sexual function, ask the experts with solid medicinal background – the helpful stuff will assist you with your questions in a timely fashion. Make use of piles of articles, reviews, notes and statistics gathered under one roof – everything you should know about erectile dysfunction and effective remedies is gathered at one place for your convenience. Just drop in at the platform and give it a try – you will love the way it works for sure.

    What Else You don’t Know about Generic Viagra: FAQs & Answers

    Our everyday goal is to provide you with affordable medicines for fast and efficient ED treatment. And though there are numerous resources available for those, who need to know more about male impotence, some questions still remain.

    We really want you to learn more about Generic Viagra and its effects. We need you to have enough information to feel safe while taking it. So, here are top FAQs and physician’s answers to them.

    Brand vs. Generic Viagra. Is there any difference?
    Actually, there is no. People believe that anything that has generic in its name is of bad quality. We still don’t understand where this idea came from. Today we are trying to convince our patients of the false of this opinion. Ingredients and elements in both drug types are identical. So are the effects.

    Brand Viagra vs Generic Viagra:

    People call it aphrodisiac. Can Viagra be regarded as such?
    You may say it for fun. But don’t take it seriously, because these pills never increase the sexual need as aphrodisiacs do. Generic Viagra only helps those, who are sexually inspired. When relationship crisis is the reason for impotence, no blue pill can cure it.

    Can Generic Viagra cure ED?
    Unfortunately, it can’t. In fact, neither of existing drugs can. We call them dysfunction treatment medicines, yet they all are only permanent solutions. Recently there has appeared a theory that these pills can be taken regularly to help men be ready whenever needed.

    Is it safe to take pills daily?
    If a man consults his physician, this variant may be suggested. Though cases are rare. Besides, to escape side effects and ensure best results a proper dose should be chosen. That may be tough, so only a few doctors do that.

    You’ve mentioned the dosage. Could you tell what the recommended dose is?
    As I’ve mentioned, it’s the physician who can decide what doses are suitable in different cases. The prescription will depend on numerous factors. However, 50mg are regarded as the most frequent and suitable choice. The pill is taken 40-60 minutes before the intercourse. The time difference depends on toleration and efficacy. Sometimes the dose either decreases to 25mg or increases to 100mg.

    And for how long does the pill work?
    It depends. On average, it functions during 5 hours. The first two hours are characterized by a very high plasma concentration. Then the action subsides, but gradually. Some men state that the effect wasn’t as great as they expected (2-3 hours). I have an answer to that too. And it sounds like much alcohol and fattening foods. Don’t expect pills to work for more than six hours. If they do, don’t get too excited. It’s the first symptom of the problem that requires medical examination.

    One may read much about Viagra interaction with other pills. So, should one refuse from other treatment courses and medicines, while he’s trying to manage his ED problems?
    Refusing from serious treatment courses to give way to Viagra is surely not the way out. And you are right: Generic Viagra interacts with many various drugs. However, this isn’t necessary the interaction that leads to lethal outcomes. It should never be mixed with medicines that include nitroglycerin as the combination of this sort will surely lead to blood flow problems or even a heart attack.

    What about other medicines?
    Professional examination and consultation will help dot the i’s and cross the t’s.

    We recommend to read Generic Viagra Online Guide by Canadian Health&Care Group:

    Are there any foods that these pills should not be mixed with?
    Yes, there are. Though their list is short. I’ve mentioned fattening foods and alcohol. You can drink some wine and eat fries or steak, of course. But in moderation. Too much alcohol will lead to vision changes and even dizziness. Too much fattening foods will increase the time amount required for pills’ effective work. What I want to add to the list is grapefruit juice.

    Really? Never though it could cause any problems…
    No one did. FYI, grapefruit juice prevents Viagra from absorbing into the system. Generic Viagra can increase in man’s blood and lead to side effects. Some of them are really dangerous.

    What minor or serious side effects are the commonest? And what is more important: can males escape them all?
    Any drug can cause side effects. Frankly speaking, it is even normal to experience side effects, because they always come with positive ones. Consumption of the generic product is not an exception. The severity or mildness depends on the dose being taken. Mild ones can include head- or stomach ache, dizziness or nausea. They are absolutely harmless, so there’s nothing to get worried about.

    What about severe cases?
    These are rarely reported. They develop after the combination of pills with the foods and beverages mentioned above. If there is an abnormal heart rate or chest pain, a man should rush to the hospital.

    Is there any advice for those, who faced ED?
    Well, the only tip I can give is not to hesitate over professional examination. The sooner you go to your physician, the faster your sexual life gets back to norm.

    Thanks for tips and recommendations. We hope they will be handy for millions of ED sufferers.
    It was a pleasure to share some important facts.

    Generic Viagra at Canadian Pharmacy: the benefits of generic drugs and why choose us

    Sexual activities play an important part in the lives of all men, which means that it’s essential to take care of one’s health if you want to enjoy sex regardless of your age. Erectile dysfunction is a widespread sexual heath disorder that prevents men from achieving or maintaining erections and thus making it impossible to engage in sexual activities. Besides physical influence, this condition also affects men psychologically by undermining their self-esteem and negatively affecting their relationships, especially when men feel uncomfortable discussing the problem. In the majority of cases, men experience erectile dysfunction because of various health problems that disturb the blood flow in the body. In such a way, the goal of modern ED drugs is to provide sufficient amount of blood to the penis during sexual stimulation, so that the erection can last for the entire intercourse.

    Why do the customers prefer Generic Viagra to its brand-name counterpart?

    Nowadays, customers become more and more familiar with the idea of purchasing generic drugs instead of their more expensive brand-name versions. It’s not a secret that there is a correlation between the price of the drugs and how well-known and respected the pharmaceutical company is. Fortunately, once the patent that protects the medication is no longer valid, the medications can be reproduced by other manufacturers and sold at more affordable prices. Naturally, no one wants to pay a significant amount of money for a famous name on the packaging, and generic drugs give you a chance to pay for the actual medication.

    When we talk about men’s sexual health, there is an abundance of medications on the market created to treat erectile dysfunction, which makes it possible for a man to lead an active sexual life for many years. Because ED drugs do not provide permanent cure to the erectile problems and in most cases men have to consume them for prolonged time, the treatment becomes very expensive if you use brand-name drugs. However, when choosing to purchase the most widely recognized medication for the treatment of Erectile Dysfunction, generic Viagra, you save a lot of money but enjoy the same results.

    Canadian generic Viagra is equivalent in its properties and recommendations to consumption to its brand-name counterpart, as it is created in the same way and using the same components. All you have to do is take a pill of generic Viagra 30 minutes to an hour before intercourse, and you will be able to achieve erections for the next four hours.

    Why is it a good decision to choose the drugs at My Canadian Pharmacy?

    When it comes to ED drugs and specifically generic Viagra, it’s essential to know that you purchase the medication that works because it can be incredibly frustrating when it doesn’t provide the needed effect in the most important moment. The focus of My Canadian Pharmacy is to find the most high-quality generic drugs in a number of categories so that the customers of the service can be confident that they receive exactly the medications they order. With the help of Canadian Pharmacy, you can order the drugs without any troubles and representatives of the online service will choose the most affordable options for you. Canadian Viagra has long been appreciated by men diagnosed with erectile dysfunction because it allows them to enjoy the great performance in bed and also save the money that they can spend on something pleasant.

    Besides affordability, there are a number of other contributing factors that make Canadian Pharmacy a perfect choice for when you need to obtain top-quality medications:

    • Short-term delivery of medications to your location
    • Availability of the customer support representatives that have extensive experience in the pharmaceutical field and are able to help you select a suitable drug
    • Frequent discounts and bonuses that give you an opportunity to get the drugs for even lower prices
    • Complete confidentiality of your personal information
    • Straightforward and simple system of ordering
    • A collection of articles to improve your understanding of ED and its treatment

    In such a way, shopping online for ED drugs is a lot less stressful and requires almost zero effort on your part. The representatives of Canadian Pharmacy team always put an emphasis on the quality of drugs and continuous improvement of the services so you can always rely on their expertise.

    Visit Canadian Pharmacy website and choose best Canadian Viagra Online –

    Probably the most disturbing issue of each citizen nowadays is his/her health. In search of the best place to buy drugs we pay attention to the smallest detail. Local drugstores do not always offer cheap and quality medications, that is why more and more often customers are resorting to online ones. Low prices and a wide range of drugs are the main attraction of the pharmacies found on the Internet. However, opting for any medication, one should check the company carefully and purchase only from a reliable one.

    Canadian Health&Care Mall can boast of years of international recognition and successful cooperation with customers all around the globe. All the attention of pharmacy’s staff is focused on satisfying the clients’ consuming desires. The diversity of medications, their prices, customer support and policies offered are among those beneficial options that incline people to make a purchase here.

    Correlation of Price and Quality

    Antibiotics, eye and skin care, blood pressure, antibiotics, men’s and women’s health and many other medications are displayed at the online Canadian Pharmacy. The variety consists of qualitative medications, tested and approved on the highest pharmaceutical levels. Due to the fact that not only brand, but generic drugs are offered, the prices are rather competitive. The most dependable manufacturers provide the pharmacy with the best medicines at the most acceptable cost. The vast majority of medications does not bear brand names, though includes the same active ingredients as their expensive counterparts. So, here you have a perfect opportunity to get the same effective medication at a much lower price.

    Time-Tested Services of CHCM

    Apart from great quality exceeding the price, the services offered by Canadian Health&Care Pharmacy are doubtlessly the key advantages of the online drugstore. First of all, the website is simple to use, easy to navigate and find the necessary treatment. Besides, in case of any issues appeared you will be offered help from the customer support service. It is available 24 hours a day, 7 days a week and ready to solve all the problems and help you with the tiniest misunderstandings.

    A team of professional doctors is also ready to assist you in choosing the medication. You can get online consultations of an experienced physician who will recommend you the necessary dosage, pill type and strength. The privacy policy provided by the online pharmacy will keep your personal information confidential and it will not be passed to the third party. Your private data, tests results and condition, as well as the drugs bought, will be only between you and the drugstore. Easy purchasing process and fast delivery will make you appreciate the platform even more. Order relevant medications and receive them right at the door, enjoy the quality, price and services offered by Canadian online Pharmacy and you will never regret your choice.

    Music, in the physical world, is needed for organizing the disorganized matter. The physical world is disorganized. Through music matter vibrates harmoniously.

    Music is a Divine way for success in the world. Through music higher beings reach us. You, if you sing, will contribute for more advanced creatures to come and help you. If you do not sing, they will not be interested in you.

    Occult science recommends singing as a method for converting the negative energies into positive.

    Music organizes the body and from there – the thought. It organizes the thought and from there – all cells. Music raises the vibrations of the organism.

    Music is used from long ago as a method for transforming of the energies and for treatment.

    Singing is an appeal of the human soul to Nature. Being responsive, it sends its reasonable building powers toward a person to help him recover sooner.

    Today music can be harnessed as a method of treatment Ed Viagra Australia. If you make somebody, who is ill, sing a little every day, he will soon recover. On the other hand, if one, who is healthy, stops singing, he will easily fall ill. Music is the boundary between the physical and spiritual worlds. Through it, man can transform his energies. Through a song, a particular vital energy flows into the human body. If you are nervous, indisposed, start singing. Your condition will change right away. By singing such abilities are developed, which may not develop in another way.

    In order one to be healthy and develop normally, he should gain an inner balance between the powers of the matter, of which his body is made, as well as between his thoughts and feelings. Music is one of the means for maintaining that balance. One, who knows the laws of natural music, can stop the destructive activity of the parasites in his body and improve his condition.

    Singing is not entertainment, it is a means of toning up the energies. You shall sing to gain certain energies. If a patient does not sing, he will die prematurely. He should sing to provide the lost energy to his organism.

    When one sings, he has to put in the song his soul and his spirit. They change the vibrations, raise them, and each increase of the vibrations has a healthy effect on the organism.

    When you sing, Love, Wisdom and Truth must take part in your singing to express everything that God has put in you.

    Many of the modern doctors, particularly in the West, treat patients by music. Bulgarians are pessimist by nature, that is why they have created horo-songs to take treatments for their pessimism. Joyful music has a healthy effect. There are sad songs that may make even a healthy person ill. Bulgarian horo-songs are healing.

    At each pain capillaries contract. When you start singing, expansion happens and that contraction of capillaries stops, pains stop.

    Music is a way for transforming human conditions. There are conditions that cannot be changed without music.

    You have not used music yet as a means for healing and developing of your abilities. Through music you can produce power in yourself, remove discouragement, or remove your pains. You will sing one, two, three, four, five times a tone or the entire scale and you will see how your situation will improve.

    Both herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) can cause primary infection of the genital tract, and HSV-1 infection has become an increasingly frequent cause of genital disease. The majority of HSV infections are asymptomatic, and only 10 to 25% of persons with HSV-2 antibodies have recurrent genital disease. Transmission of HSV from infected women to neonates may lead to severe neurologic disease or death in the newborn. Strategies to control genital herpes infection and disease have mainly focused on antiviral chemotherapy, education, and the use of condoms. The availability of an effective prophylactic vaccine would help control genital herpes.

    In two previous efficacy trials of an HSV-2 glycoprotein D–based subunit (gD-2) vaccine in discordant couples in which one partner had recurrent HSV genital disease, the subset of seronegative women (negative for both HSV-1 and HSV-2 antibodies) was significantly protected against HSV-2 disease by the vaccine (73% and 74% efficacy, respectively); efficacy was not shown in either men or HSV-1–seropositive women.4 To further evaluate the gD-2 vaccine as a potential public health tool, we evaluated this vaccine in a cohort of women who were screened and found to be antibody-negative for HSV-1 and HSV-2.

    Study Population

    Women 18 to 30 years of age who were seronegative for HSV-1 and HSV-2 were recruited from 40 sites in the United States and 10 in Canada. Other inclusion criteria were written informed consent, the absence of serious health problems, a willingness to use effective methods of birth control throughout the period from 30 days before vaccination to 2 months after receipt of the third dose of vaccine, and a negative pregnancy test.

    Vaccines and Adjuvants

    The HSV-2 vaccine (GlaxoSmithKline) contained 20 μg of truncated glycoprotein D from HSV-2 strain G. The gD-2 vaccine antigen was combined with an adjuvant that consisted of 0.5 mg of aluminum hydroxide (alum) and 50 μg of 3-O-deacylated monophosphoryl lipid A. The vaccine was administered by injection at a dose of 0.5 ml at 0, 1, and 6 months.

    Thus, a conspicuous feature of the mammalian transport apparatus is its great complexity. There are more transport strategies, types of vesicles, and trafficking pathways than was expected until only a few years ago. Also, each anterograde trafficking step is counterbalanced by one or more recycling steps, and most of the various endocytic stations appear to be interconnected bidirectionally.31 Moreover, certain specialized cells host uniquely differentiated organelles (e.g., secretory granules in endocrine and exocrine cells, melanosomes in melanocytes, lytic granules in immune cells, and dense granules in platelets), and at least in some cells (and potentially in all) there are unconventional secretion pathways through which a number of soluble cytosolic proteins can be transported directly to the extracellular space and some transmembrane proteins can be transported to the cell surface without passing through the Golgi complex32.

    A consequence of this multiplicity is a remarkable degree of redundancy and functional plasticity of the transport systems. This redundancy can partially compensate for certain genetic defects, and it can do so more efficiently in some cells than in others, depending on cell-specific requirements, which results in the selective vulnerability of certain tissues.

    Another important issue is how the overall trafficking system maintains its homeostasis in the face of the rapid membrane fluxes that constantly change the size and composition of the transport organelles, or compartments. Among several possible mechanisms, one that has been recently explored relies on signaling circuits located on the trafficking organelles themselves that sense the passage of traffic and rapidly react to restore the balance across the compartments.

    Mechanistic Basis

    During the past decade, the increasingly rapid discovery of genes that are linked to human diseases has revealed that several such genes are involved in membrane trafficking. Efforts are now being more specifically directed toward understanding how disease manifestations can be mechanistically explained through our basic knowledge of the trafficking machinery and toward exploiting this new knowledge of the molecular basis of genetic syndromes to obtain insights into the organization of the trafficking processes.

    Mendelian diseases of membrane trafficking arise from mutations in genes that encode either cargo proteins or components of the biosynthetic and trafficking machinery. Among these genes, those that encode cargo proteins are more widely represented because they are more numerous and because many cargoes are tissue-specific and not essential for the survival of an embryo. On the other hand, mutations in genes that encode ubiquitous transport-machinery proteins are more likely to be lethal. Nevertheless, several of these mutations have been found to be involved in mendelian diseases, and more continue to be reported. Probably some of these mutations can, under favorable conditions, be partially compensated for by the plasticity of the transport systems.

    However, short-term ADT is not without quality-of-life consequences, including hot flashes and higher rates of erectile dysfunction than with radiotherapy alone. Furthermore, erectile dysfunction may be less responsive to interventions after combined therapy than after radiotherapy alone. In prospective studies, short-term ADT caused measurable muscle loss, fat accumulation, decreased insulin sensitivity, and increased cholesterol and triglyceride levels. In the current study, the 10-year disease-specific mortality in the radiotherapy-alone group was 1%, a finding that does not provide support for the addition of short-term ADT in patients with low-risk prostate cancer. A total of 395 black men participated in this study, allowing evaluation according to racial subgroups. Similar benefits from short-term ADT were seen in the white and black populations with respect to the 10-year rate of overall survival, 10-year disease-specific mortality, and biochemical failure. Overall survival among black men was worse than that among white men, but disease-specific mortality was similar.

    The results of our trial show that the addition of short-term ADT provides a survival benefit for men with intermediate-risk prostate cancer who receive conventional doses of radiotherapy. In addition, our findings suggest a biologic interaction between short-term ADT and radiotherapy, in contrast to several randomized trials of surgery combined with short-term ADT, which did not show a benefit with respect to outcome. The adoption of current radiotherapy techniques such as intensity-modulated radiation therapy, intensity-guided radiation therapy, and lowdose-rate and high-dose-rate brachytherapy now permits the safe delivery of higher doses of radiation than was possible when this study was conducted. These techniques have also been associated with improved efficacy,36-39 bringing into question the value of adding short-term ADT in men with intermediate-risk cancers treated with current irradiation methods. The RTOG has opened a successor study, RTOG 08-15 (NCT00936390), to address this question.

    The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute. Supported by grants (U10 CA21661, to the Radiation Therapy Oncology Group [RTOG]; U10 CA37422, to the Community Clinical Oncology Program; and U10 CA32115, to the RTOG Statistical Center) from the National Cancer Institute. Dr. Chetner reports receiving lecture fees from and serving on the advisory boards of Amgen, Ferring, GlaxoSmithKline, and Eli Lilly and receiving fees for the development of educational presentations from Amgen and GlaxoSmithKline; and Dr. Sandler, consulting fees from Calypso Medical and Varian. No other potential conflict of interest relevant to this article was reported.

    This phase 3 clinical trial evaluated whether the addition of short-term ADT to radiotherapy improved outcomes in patients who had early, localized prostate cancer and a PSA level of 20 ng per milliliter or less — the subgroup of patients with prostate cancer who were known to have the most favorable prognosis at the time the study was initiated. Because of the indolent nature of the disease, a median follow-up period of more than 9 years for surviving patients and vigilant PSA monitoring were required to obtain meaningful results in a patient cohort in which most deaths were due to other causes.

    The study showed that the addition of shortterm ADT to radiotherapy conferred a modest but significant increase in the 10-year rate of overall survival, from 57 to 62%. This increase was accompanied by a significant reduction in 10-year disease-specific mortality from 8% to 4% as well as reductions in the secondary end points of biochemical failure, distant metastases, and the rate of positive findings on repeat prostate biopsy at 2 years. The Gleason score was the only independent prognostic predictor for all end points measured. The lack of surgical staging for regional lymph nodes did not predict poor outcomes, validating the current practice of clinical staging in patients receiving radiotherapy. The efficacy gains were achieved with minimal temporary acute hepatic toxic effects and some decreased erectile function at 1 year, but with no increased risk of death from intercurrent disease, serious cardiovascular toxic effects, or acute or long-term gastrointestinal or genitourinary complications of radiotherapy. The rate of erectile dysfunction observed in this study is similar to that reported in previous studies that involved the use of similar doses of radiotherapy.

    Reanalysis of the data according to risk subgroups showed that the gains in overall survival and reductions in disease-specific mortality were mainly limited to men in the intermediate-risk subgroup, with a number needed to treat of 14 based on the difference in overall survival seen at 10 years. Although the addition of short-term ADT to radiotherapy also appeared to be beneficial in the high-risk patients, the persistent significant increase in 10-year disease-specific mortality provides support for observations from other clinical trials showing that more than 4 months of ADT is required for maximum benefit.

    Among men with low-risk disease, the addition of short-term ADT did not significantly increase the 10-year rate of overall survival or decrease the 10-year rate of disease-specific mortality but did significantly lower the incidence of biochemical failure and positive findings on repeat prostate biopsy at 2 years. It is conceivable that in patients with indolent disease, longer follow-up is required to show a benefit with respect to the diseasespecific mortality and overall survival rates.