Clinical stratification of de novo metastatic prostate cancer by multi-region aggregate molecular features.

Prostate cancer is the most common cancer in men in Canada, with over 4000 new cases per year. Eight percent of patients are diagnosed with disease that has already spread to other organs. This ‘de novo’ metastatic prostate cancer (mPCa) is highly aggressive and ultimately lethal. While there are several life-prolonging treatments, patient outcomes can be variable despite similar clinical presentation. Evidence from other PCa settings suggest patient outcomes are strongly influenced by the molecular features of their disease, but these features have not been assessed in de novo mPCa. To address this critical knowledge gap, I have assembled diagnostic tumor biopsy samples and blood samples from 488 British Columbians with de novo mPCa. I will use clinically-practical experimental techniques paired with cutting-edge computational approaches to stratify patients according to the specific molecular characteristics of their tumor. I will intersect these results with clinical data to understand relationships between cancer features and treatment response or resistance. Overall, this study will provide a blueprint for new precision diagnostics and tailored treatment strategies for Canadian men with aggressive prostate cancer.