In patients with low ctDNA aneuploidy, we identify a second ctDNA-positive group on the basis of detectable pathogenic tumor-derived mutations, AR-GSRs, and/or copy gains in AR, MYC or MYCN. We assign these patients to a ctDNA aneuploidy-low Group 2, and demonstrate they also have shorter rPFS and OS compared with patients in ctDNA-negative Group 3. Here, MYCN is linked to neoplasm.