CONSORT diagram of the patient cohort. Of 2,641 patients who underwent RP between 1987 and 2004, a cohort of 501 patients was selected using a 1:3 sampling design, which included all 127 patients who did and 374 patients who did not have a clinical recurrence. The final analysis cohort consisted of 428 patients with evaluable primary Gleason pattern in the RP tissue and valid GPS results after excluding pathological and laboratory failures. GPS, Genomic Prostate Score; RP, radical prostatectomy.