Gene

Genetic heterogeneity

Biology

Prostate cancer

Epigenetics

Chromoplexy

Tumour heterogeneity

PCA3

Tumor heterogeneity

Somatic evolution in cancer

Computational biology

Genetics

Bioinformatics

Precision medicine

Internal medicine

Prostate

Oncology

Medicine

Disease

Cancer

Phenotype

Pathology

Nature Reviews Urology

From a clinical, morphological and molecular perspective, prostate cancer is a heterogeneous disease. Primary prostate cancers are often multifocal, having topographically and morphologically distinct tumour foci. Sequencing studies have revealed that individual tumour foci can arise as clonally distinct lesions with no shared driver gene alterations. This finding demonstrates that multiple genomically and phenotypically distinct primary prostate cancers can be present in an individual patient. Lethal metastatic prostate cancer seems to arise from a single clone in the primary tumour but can exhibit subclonal heterogeneity at the genomic, epigenetic and phenotypic levels. Collectively, this complex heterogeneous constellation of molecular alterations poses obstacles for the diagnosis and treatment of prostate cancer. However, advances in our understanding of intra-tumoural heterogeneity and the development of novel technologies will allow us to navigate these challenges, refine approaches for translational research and ultimately improve patient care.

Genomic and phenotypic heterogeneity in prostate cancer