Prospective Prolaris Value and Efficacy

This is a prospective study to measure the impact on first-line therapy of genomic testing of
biopsy tissue from recently diagnosed treatment-naïve patients with early stage localized
prostate cancer. Multiple individual VAMC sites will participate in PART 1 of the study.
During PART 1 of the study, a three-part questionnaire will be completed to evaluate the
PRE-Prolaris test treatment plan, the POST-Prolaris test treatment plan, and the ACTUAL
treatment option. Using PRE-Prolaris Test Questionnaire #1 the physician will record the
recommendation for first-line therapy based on standard clinical-pathological parameters
(PSA, Gleason score, clinical stage and percent positive cores). The likelihood of
recommending a non-interventional therapy approach will also be recorded using a 10-point
ordinal scale. A sample of the biopsy tissue will then be tested using the Prolaris® genomic
test and a relative cancer aggressiveness score will be shared with the physician. After
reviewing and considering the results of the genomic testing and after patient consultation,
the physician will complete POST-Prolaris Questionnaire #2 documenting the planned treatment
( interventional treatment or non-interventional). Approximately 6 months from the date of
the test results, ACTUAL Treatment Questionnaire #3 will be completed to document the actual
treatment administered.

PART 2 of this study is a prospective evaluation of the prognostic utility of Prolaris®
testing of prostate biopsy samples obtained from men who participate in PART 1of the study
and who undergo radical prostatectomy or radiation therapy or who are managed with WW or AS.
The central VAMC site will be responsible for PART 2; individual VAMC sites will not
participate in this part of the study. Patients will be followed using medical record review
every 6 months for objective progression (BCR, radiographic or radionuclide evidence of
metastases or disease specific mortality) through 5 years.

Inclusion Criteria:

- Newly diagnosed (<= 6 months), untreated patients with histologically proven
adenocarcinoma of the prostate

- Final treatment decision has not been made (that is all treatment options are feasible
and none have been ruled out due to comorbidities at study entry)

- Clinically localized (no evidence on clinical or imaging studies of advanced disease)

- No hormonal therapy for treatment of prostate cancer including LHRH agonist or
antagonist, anti-androgen, estrogens or exogenous androgens when applicable (use of
5-alpha reductase inhibitors is acceptable)

- Sufficient amount of tissue remains from biopsy to perform genomic testing

- Life expectance of a minimum of 10 years

- Men who completed PART 1 and were treated with radical prostatectomy (including
robotic, laparoscopic, open retropubic or perineal) or receive radiation therapy or
were placed on AS or WW.

Exclusion Criteria:

- Men with clinical node positive or metastatic disease

- Men with a known baseline total serum testosterone level of <100 ng/dL prior to
radiation or hormone therapy (men with unknown baseline testosterone levels will not
be excluded)

- Men who previously received pelvic radiotherapy for another malignancy

- Non adenocarcinoma prostate cancer histologies