Schematic of study design. Two cohorts of patients with localized PCa, who were followed up prospectively, were included in this study. In phase I and II, we aimed to elucidate SNPs that were associated with PCa aggressiveness using the MDACC-PCa cohort of patients who underwent PCa treatment. Two criteria (GS≥8 vs.GS≤6 and D’Amico high risk vs. low risk) were used to define aggressive disease in phase I, while the risk of GS4 + 3 in GS7 patients was evaluated in phase II; In phase III, we investigated SNPs associated with disease reclassification in the AS cohort.