Germline and somatic DNA repair gene mutations are common in recurrent and advanced prostate cancer, but their clinical implications are understudied. This talk will review the prevalence and types of DNA repair mutations in localized and metastatic prostate cancer, and will then outline the therapeutic implications of DNA repair deficiency in the context of hormonal therapies, chemotherapies, radiopharmaceutical agents, PARP inhibitors and PD-1 inhibitors. Unanswered questions will be posed, and future directions will be proposed.