Clinically, visceral metastatic PC is known to act more aggressively than metastases to lymph nodes or bone without visceral involvement, a distinction made in several clinical trials.11,12 This analysis suggests an association between genomics and metastatic seeding: on top of the homozygous deletions of tumor suppressors and amplification of AR seen in nodal metastases, lung involvement was defined by mutations in AR and ITSN1 and liver involvement was defined by mutations in genes involved in epigenetic regulation, ARID5B and HIST1H1C. This evidence concerns the gene ITSN1 and pachyonychia congenita.