The prevalence of SPINK1 outlier expression or ETS genetic rearrangement status among prostate cancer (PCa) patients is largely unknown in India. This project proposes to characterize the full spectrum of the PCa specific driver aberrations in a large cohort of Indian prostate cancer specimens, with specific focus on estimating the prevalence of SPINK1 over-expression. Therefore, this study, a first of its kind, will provide a thorough understanding of causal genomic events of PCa in the Indian population. Furthermore, this will also unravel the underlying mechanism for the increased SPINK1 expression in a subset of aggressive Pca and its role in cancer metastases. This comprehensive study will also explore the potential of SPINK1 to serve as a therapeutic target in SPINK1+ PCa patients.