However, it is important to note that our conclusion suggesting that the metastatic phenotype and patient prognosis after ADT can be predicted by examining specific characteristic of the diagnostic primary tumor biopsies applies to patients similar to the ones examined here, i.e., to patients with already established metastatic disease at diagnosis, where the serum PSA, ISUP grades, and Ki67 labeling index are higher than in the average patient diagnosed with PC [12](see also www.npcr.se, accessed on 1 September 2021). This evidence concerns the gene MKI67 and metastatic neoplasm.