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Prostate cancer heterogeneity








                • Prostate cancer is a highly heterogeneous group of diseases


                       • Intra-patient heterogeneity


                              • Admixed in gross biopsy

                              • RB1 loss; AR-V7; WNT aberrations

                       • Inter-patient heterogeneity

                              • BRCA2/ATM/HRD and PARPi/platinum

                              • MMRd and PD-1/PD-L1


                              • CDK12 mutations and PD-1/PD-L1
                              • PTEN loss and AKTi


                              • SPOP: Do very well on abiraterone
                              • WNT and poor ARSI response


                              • RB1/TP53: Poor outcome (low PSMA)

                                     • Luminal to basal switch






         Robinson et al, Cell 2015; Kumar et al, Nature Medicine 2016; Gundem et al, Nature 2015; Nava Rodrigues et al, JCI 2018
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