Darst BF, Dadaev T, Saunders E, et al. - This study was sought to evaluate if rare pathogenic, likely pathogenic, or deleterious (P/LP/D) germline variants in DNA repair genes are correlated with aggressive prostate cancer (PCa) risk in a case-case study of aggressive versus non-aggressive disease. Researchers recruited a total of 5,545 European-ancestry men, including 2,775 non-aggressive and 2,770 aggressive PCa cases, which included 467 metastatic cases (16.9%).  The single variant, gene-based, and DNA repair pathway-based burdens were compared by disease aggressiveness. The results suggested that the risk conveyed by DNA repair genes is largely driven by rare P/LP/D alleles within BRCA2, PALB2, and ATM. These data help the importance of these genes in both screening and disease management considerations.