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Blood-Based Biomarkers of Aggressive Prostate Cancer 1 2 3 3 2 1 Men Long Liong , Chun Ren Lim , Hengxuan Yang , Samuel Chao , Chin Wei Bong , Wing Seng Leong , 1 4 5 2 2 6 Prashanta Kumar Das , Chit Sin Loh , Ban Eng Lau , Choon Geok Yu , Edie Jian Jiek Ooi , Robert K. Nam , 7 7 3 7 3,7 Paul D. Allen , Graeme S. Steele , Karl Wassmann , Jerome P. Richie *, Choong Chin Liew 1 Lam Wah Ee Hospital, Georgetown, Penang, Malaysia, 2 GeneNews (Malaysia), Mount Miriam Cancer Hospital, Penang, Malaysia, 3 GeneNews Ltd, Richmond Hill, Ontario, Canada, 4 Gleneagles Intan Medical Centre, Kuala Lumpur, Malaysia, 5 Loh Guan Lye Hospital, Penang, Malaysia, 6 Sunnybrook Health Sciences Centre,Toronto, Ontario, Canada, 7 Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America Abstract Purpose: Prostate cancer is a bimodal disease with aggressive and indolent forms. Current prostate-specific-antigen testing and digital rectal examination screening provide ambiguous results leading to both under-and over-treatment. Accurate, consistent diagnosis is crucial to risk-stratify patients and facilitate clinical decision making as to treatment versus active surveillance. Diagnosis is currently achieved by needle biopsy, a painful procedure. Thus, there is a clinical need for a minimally-invasive test to determine prostate cancer aggressiveness. A blood sample to predict Gleason score, which is known to