Royal College of Surgeons in Ireland
Development, validation, and clinical utility of a six-gene signature to predict aggressive prostate cancer.pdf (2.23 MB)

Development, validation, and clinical utility of a six-gene signature to predict aggressive prostate cancer

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journal contribution
posted on 2024-05-31, 15:41 authored by Agnieszka Krzyzanowska, Stephen Barron, Debra F Higgins, Tony Loughman, Amanda O'Neill, Katherine SheehanKatherine Sheehan, Chan-Ju Angel Wang, Bozena Fender, Leah McGuire, Joanna FayJoanna Fay, Anthony O'GradyAnthony O'Grady, Des O'Leary, R William Watson, Anders Bjartell, William M Gallagher

Background: Molecular signatures in prostate cancer (PCa) tissue can provide useful prognostic information to improve the understanding of a patient's risk of harbouring aggressive disease.

Objective: To develop and validate a gene signature that adds independent prognostic information to clinical parameters for better treatment decisions and patient management.

Design, setting, and participants: Expression of 14 genes was evaluated in radical prostatectomy (RP) tissue from an Irish cohort of PCa patients (n = 426). A six-gene molecular risk score (MRS) was identified with strong prognostic performance to predict adverse pathology (AP) at RP or biochemical recurrence (BCR). The MRS was combined with the Cancer of the Prostate Risk Assessment (CAPRA) score, to create a molecular and clinical risk score (MCRS), and validated in a Swedish cohort (n = 203).

Outcome measurements and statistical analysis: The primary AP outcome was assessed by the likelihood ratio statistics and area under the receiver operating characteristics curves (AUC) from logistic regression models. The secondary time to BCR outcome was assessed by likelihood ratio statistics and C-indexes from Cox proportional hazard regression models.

Results and limitations: The six-gene signature was significantly (p < 0.0001) prognostic and added significant prognostic value to clinicopathological features for AP and BCR outcomes. For both outcomes, both the MRS and the MCRS increased the AUC/C-index when added to European Association of Urology (EAU) and CAPRA scores. Limitations include the retrospective nature of this study.

Conclusions: The six-gene signature has strong performance for the prediction of AP and BCR in an independent clinical validation study. MCRS improves prognostic evaluation and can optimise patient management after RP.

Patient summary: We found that the expression panel of six genes can help predict whether a patient is likely to have a disease recurrence after radical prostatectomy surgery.


OncoAssure Ltd

Irish Cancer Society (PCI11WAT) for the Prostate Cancer Research Consortium biocollection

Science Foundation Ireland (15/IA/3104, 17/IFB/5394 and 18/SPP/3522)

Swedish Cancer Society (Cancerfonden, 21 1629 Pj 01 H)

Swedish Scientific Council (Vetenskapsr├ądet, 2020-02017)

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The original article is available at

Published Citation

Krzyzanowska A. et al. Development, validation, and clinical utility of a six-gene signature to predict aggressive prostate cancer. Eur Urol Focus. 2023;9(6):983-991.

Publication Date

25 April 2023

PubMed ID



  • Beaumont Hospital
  • Pathology

Research Area

  • Cancer


Elsevier BV


  • Published Version (Version of Record)