Prostate cancer is the leading cancer diagnosis among men in the United States with an estimated 248,530 new cases expected and is the second most common cause of cancer death for men in the United States, responsible for an estimated 34,130 deaths in 2021.1 It is a heterogeneous disease with locoregional cancers carrying an excellent five-year overall survival of nearly 100% in stark contrast to aggressive and lethal phenotypes that carry poor outcomes despite advances in systemic therapy. The rising incidence of young men presenting with aggressive disease phenotypes has been particularly challenging for the medical community,2 and our study, therefore, sought to describe the clinical and molecular features of early-onset prostate cancer on a large scale.