Objective To identify chromosomal regions important for progression in clinically organ-con®ned prostate cancer, as the genetic changes underlying the development and progression of prostate cancer are poorly understood. Materials and methods Comparative genomic hybridization (CGH) was used to search for DNA sequence copy-number changes in a series of 50 primary organcon®ned prostate adenocarcinomas (pT2N0) removed by radical prostatectomy. Results CGH analysis indicated that 23 (46%) of the primary prostate adenocarcinomas showed chromosome alterations. The percentage of tumours with losses (38%) was higher than with gains (28%). Losses of 13q (24%), 8p (18%), 6q (10%), 16q (8%), 18q (6%) and 5q (6%) and gains of 17q (12%), 20q (12%), 9q (10%), 17p (8%) and 8q (6%) were the most frequent alterations. Ampli®cations were found at 8q24-qter. Minimal overlapping regions of loss, indicative of the presence of tumour-suppressor genes, were mapped to 13q21.1-q21.3 and 8p21.2, and minimal overlapping regions of gain, indicative of the presence of oncogenes, were found at 9q34.4-qter, 17q25-qter and 20q13.3-qter. There was a signi®cant association between Gleason score and losses and gains (P=0.003), and an association between chromosomal imbalance and high histological grade (P=0.008). Conclusion These results suggest that losses or gains of DNA in these regions are important for prostate cancer progression, and document the spectrum of chromosomal alterations in stage pT2N0 of clinically organ-con®ned prostate cancer.