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Genomic Classification to Predict Survival in Metastatic Prostate Cancer: Development of Somatic Tumor Risk
Martin W Schoen1,2, Jiannong Li3,4, Sihang Zeng5,6,7
1Saint Louis University School of Medicine, St Louis, MO.
JCO Precision Oncology
|July 15, 2026
Summary
A new DNA-based classification, STRATOS-P, uses comprehensive genomic profiling to predict overall survival in metastatic hormone-sensitive prostate cancer (mHSPC). This validated tool stratifies patients into risk groups, aiding treatment decisions for prostate cancer patients.
Area of Science:
- Oncology
- Genomics
- Prostate Cancer Research
Background:
- Comprehensive genomic profiling (CGP) has transformed cancer care, enabling targeted therapies.
- In metastatic hormone-sensitive prostate cancer (mHSPC), prognostic biomarkers are crucial for guiding treatment decisions.
- Existing prognostic models for mHSPC often lack a comprehensive genomic approach that considers combined alterations.
Purpose of the Study:
- To develop and validate a DNA-based CGP classification for prognostic risk stratification in mHSPC.
- To assess the association between genomic alterations and overall survival (OS) in mHSPC.
- To create a tool that can inform clinical decision-making for mHSPC patients.
Main Methods:
- Retrospective analysis of US veterans with synchronous mHSPC and available CGP data.
- Development of multivariable models to identify prognostic genomic alterations.
- Creation of the Somatic Tumor Risk Assessment for OS-Prostate (STRATOS-P) classification based on mortality risk.
- Validation in an independent external cohort.
Main Results:
- Sixteen survival-associated genes were identified, leading to the STRATOS-P classification into favorable, intermediate, and unfavorable groups.
- The STRATOS-P classification demonstrated significant prognostic value for OS in both training and testing datasets (AUC 0.83).
- External validation confirmed the prognostic capability of STRATOS-P across different disease states (AUC 0.79).
Conclusions:
- Tumor DNA genomic alterations are independently prognostic for overall survival in metastatic prostate cancer.
- The STRATOS-P classification is a validated, robust prognostic tool for mHSPC.
- STRATOS-P has the potential to guide treatment decisions and personalize care for mHSPC patients.
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