The multivariate analysis showed that a Gleason score of 7 or higher was a negative prognostic factor for overall survival, disease-specific mortality, distant metastases, and biochemical failure. Other identified negative prognostic factors were older age and nonwhite race or ethnic group for overall survival, clinical T2 lesions for diseasespecific mortality, and a PSA level of 4 ng per milliliter or higher for biochemical failure. A total of 439 patients (44%) in the combinedtherapy group and 404 (41%) in the radiotherapyalone group underwent a repeat prostate biopsy at 2 years. The initial Gleason scores, PSA values, and rates of biochemical failure at 2 years were similar between the patients who underwent biopsy and those who did not undergo biopsy. Persistent cancer was detected in 20% of the biopsy specimens in the combined-therapy group as compared with 39% in the radiotherapy-alone group (P<0.001).

Patient-Reported Erectile Dysfunction
At the pretreatment, 1-year, and 2-year evaluations, the Sexual Adjustment Questionnaire completion rates were 88%, 70%, and 27%, respectively. Before treatment, 48% of the respondents in the combined-therapy group and 54% of those in the radiotherapy-alone group reported that they were “always or almost always able to have an erection” (P = 0.15); the respective rates at 1 year were 21% and 31% (P = 0.004) (Table 3). Scores at 1 year, as compared with the pretreatment scores, were improved in 9% of the patients, the same in 33%, and worse in 58%, with no significant differences between the groups.

Toxic Effects
In the group treated with short-term ADT, the proportions of patients who had acute hepatic toxic effects (occurring up to 90 days after the start of radiotherapy) of grade 1, 2, 3, and 4 were 20%, 5%, 3%, and less than 1%, respectively; late hepatic toxic effects were seen in 4%, 1%, less than 1%, and 0 of these patients, respectively, as compared with 1%, 0, 0, and 0 in the radiotherapy-alone group. In both groups, the incidences of grade 3 or higher acute and late gastrointestinal toxic effects were 1% and 3%, respectively, with grade 5 toxic effects in three patients; two patients receiving radiotherapy alone died of obstruction of the colon, and one patient treated with radiotherapy plus short-term ADT died of colorectal bleeding. Acute grade 3 or higher genitourinary toxic effects were seen in 2% of patients in both groups, with late toxic effects in 8% of patients in the combined-therapy group and 6% of those in the radiotherapy-alone group. During the 8 weeks of short-term ADT before the start of radiotherapy (in the combined-therapy group), 55% of patients had hot flashes, 3% had rash, and the incidences of hepatic toxic effects, decreased hemoglobin levels, and elevated whitecell counts were 16%, 16%, and 4%, respectively (all grade 1). Grade 1 cardiac toxic effects were observed in 11 patients (1%) within 2 years after treatment.