Journal
EUROPEAN UROLOGY FOCUS
Volume 5, Issue 3, Pages 416-424Publisher
ELSEVIER
DOI: 10.1016/j.euf.2018.01.006
Keywords
Clonal evolution; Copy number alteration; Exome sequencing; Genomic heterogeneity; Multiregion sequencing; Predictive biomarkers; Prostate cancer; Subclonal architecture; Targeted therapy
Categories
Funding
- Office of the Assistant Secretary of Defense for Health Affairs, through the Prostate Cancer Research Program [W81XWH-13-1-0451]
- University of Chicago Cancer Center Support Grant [P30 CA014599]
- Prostate Cancer Foundation
- Intramural Research Program of the National Institute of Health, National Cancer Institute, Center for Cancer Research
- US Army Medical Research Acquisition Activity, Chandler Street, Fort Detrick MD
- Grants-in-Aid for Scientific Research [15H05912] Funding Source: KAKEN
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Background: Most lethal prostate cancers progress from relapse of aggressive primary disease. Recently, the most significant advances in survival benefit from systemic therapy have come from moving the administration of therapy to an earlier disease state. There is movement toward using biomarkers from the intraprostatic index lesion to guide early systemic therapy. Objective: To determine the genomic heterogeneity, including the heterogeneity of predictive biomarkers, within the index focus of treatment-naive prostate cancer. Design, setting, and participants: Ten patients with treatment-naive prostate cancer underwent prostatectomy. DNA was extracted from 70 spatially distinct regions of the 10 index foci. Outcome measurements and statistical analysis: Single nucleotide mutations, small indels, and copy number changes were identified. Intrafocal genomic heterogeneity and heterogeneity of alterations that predict response to therapy was determined. Results and limitations: Exome sequencing and copy number estimates demonstrate branched evolution with >75% of point mutations being subclonal, including numerous pathways associated with castrate-resistant prostate cancer. Seven of 10 patients harbor alterations in one of five genes that predict response to targeted therapies with survival benefit in prostate cancer. Within biomarker-positive cases, 25% of intraprostatic regions are biomarker negative, with discordance between intraprostatic regions and lymph node metastases. Conclusions: Treatment-naive, nonmetastatic prostate cancer has marked intrafocal heterogeneity. Numerous alterations in pathways associated with castration-resistant prostate cancer are present in subclonal populations, including biomarkers predictive of response to targeted therapy. Patient summary: Untreated patients' tumors have alterations that predict response to targeted therapies, but the presence of a biomarker is dependent on what region of the tumor was evaluated. Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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