ST. LOUIS — Even though tumor comprehensive genomic profiling (CGP) has revolutionized the care of many cancers and identifies patients for biomarker-specific therapy, it had not been available for all variations.
For example, in metastatic hormone-sensitive prostate cancer (mHSPC), “although individual genes are prognostic, no comprehensive genomic classification exists using CGP that accounts for combinations of alterations to inform prognosis,” according to a new study in JCO Precision Oncology.1
In response, a study team led by Saint Louis University School of Medicine and the VA St Louis Healthcare System developed a DNA-based CGP classification that is prognostic for overall survival (OS) and could inform treatment. Other VA researchers contributing were from James A. Haley Veterans’ Hospital in Tampa, FL; the Puget Sound VA Healthcare System in Seattle; the Corporal Michael Crescenz VAMC in Philadelphia; the VA Salt Lake City, UT, Healthcare System; the VA Greater Los Angeles Healthcare System; the VA Boston Healthcare System; the VA San Diego Healthcare System; the Durham, NC, VAMC‘ and the VA National Oncology Program in Washington, DC.
The retrospective cross-sectional study used multivariable models to develop a clinicogenomic prognostic risk classification in U.S. veterans with synchronous mHSPC. Defined as the primary outcome was overall survival from time of metastasis.
Identified were 7,201 veterans with metastatic prostate cancer and CGP; 2,484 of the veterans—median age of 72 with synchronous mHSPC and tissue CGP—were divided into training and testing data sets. The researchers pinpointed 16 genes associated with survival and then created favorable, intermediate and unfavorable genomic prognostication groups based on the mortality risk to generate the Somatic Tumor Risk Assessment for OS-Prostate (STRATOS-P) classification.
“In a multivariable model, classification into intermediate and unfavorable groups was associated with increased mortality relative to the favorable group (adjusted hazard ratio [aHR], 1.54 [95% CI, 1.33 to 1.78]; aHR, 2.37 [95% CI, 1.97 to 2.485], respectively), demonstrating an average AUC of 0.83,” the study noted.
The authors advised, “In an external, nonveterans validation cohort, intermediate and unfavorable classifications were associated with increased mortality (aHR, 2.45 [95% CI, 1.87 to 3.21]; aHR, 4.37 [95% CI, 3.06 to 6.22], respectively) with an AUC of 0.79. The intermediate and unfavorable genomic prognostication groups were also associated with increased mortality across multiple disease states including synchronous and metachronous diagnoses, castration resistance, and analyte type.”
The study concluded that, in metastatic prostate cancer, tumor DNA genomic alterations are prognostic for overall survival. “The STRATOS-P classification is a validated prognostic tool that has the potential to guide decision making in mHSPC,” according to the researchers.
Background information in the article pointed out that tumor DNA alterations are fundamental to understanding cancer biology. Genomic testing can “inform clinical management, including the use of chemotherapy in early breast cancer. Similar integrative approaches in prostate cancer using RNA expression combined with clinical nomograms can improve prognostication and are being tested as potential predictive biomarkers,” they added.
- Schoen MW, Li J, Zeng S, Desai H, et. al. Genomic Classification to Predict Survival in Metastatic Prostate Cancer: Development of Somatic Tumor Risk Assessment for Overall Survival-Prostate. JCO Precis Oncol. 2026 Jul;10(7):e2600021. doi: 10.1200/PO-26-00021. Epub 2026 Jul 15. PMID: 42456085; PMCID: PMC13378758.