Precision oncology has transformed the management of prostate cancer by integrating molecular profiling, targeted therapies, and advanced diagnostic technologies into clinical practice. This chapter reviews the evolving landscape of precision medicine across the spectrum of prostate cancer, from hormone-sensitive to metastatic castration-resistant disease. Key genomic alterations—including defects in DNA damage repair pathways, alterations in PTEN/PI3K/AKT signaling, and androgen receptor aberrations—play a pivotal role in prognostication and treatment selection. The clinical impact of targeted therapies such as poly(ADP-ribose) polymerase (PARP) inhibitors, prostate-specific membrane antigen (PSMA)-directed radioligand therapy, and immune checkpoint inhibitors is examined alongside emerging data from molecular imaging and liquid biopsy technologies. Challenges in implementation—including tumor heterogeneity, limited prevalence of actionable mutations, disparities in access to genomic testing, and global inequities in precision therapy availability—are critically discussed. This chapter also highlights future directions, including AI-enabled biomarker discovery, single-cell and spatial transcriptomics, theranostics, and next-generation molecular classifiers. Together, these advances underscore a growing shift toward individualized, data-driven treatment strategies and emphasize the need for equitable integration of precision oncology into global prostate cancer care.