(UroToday.com) The disease natural history of patients with localized prostate is varied – while some men will have an indolent course without treatment, others progress quickly in spite of aggressive therapy. While clinical data, including patient demographics, prostate specific antigen levels, Gleason score, and tumor stage, among others, provide prognostic information, they remain suboptimal as they do not account for underlying tumor biology. The Decipher Genomic Classifier (GC) has been shown to independently prognosticate outcomes in prostate cancer, including the risk of metastasis on the basis of underlying tumor biology. The GC was derived and validated in predominately White cohorts. However, African American men with prostate cancer have poorer outcomes overall despite evidence that outcomes are identical when there is timely diagnosis, appropriate staging, and adequate and equitable treatment delivery.