Radical prostatectomy (RP) has been a widely accepted and standard treatment for clinically localized and locally advanced prostate cancer. However, effective clinical management of RP patient remains being challenged, given that conventional prognostic factors, including Gleason score, pT stage, surgical margin status and presurgery serum prostate-specific antigen (PSA), cannot correctly predict cancer recurrence after RP. Recently, a robust prognostic model for biochemical recurrence (BCR) and metastasis has been developed by our group at the MGH. This model was a continuous risk index based on the expression of 32 genes and was validated in an independent, blinded cohort of 270 RP patients. In multivariate analyses, the 32-gene risk index model was prognostic for risk of BCR and had added value over the traditional parameters. This model may contribute to accurate postoperative treatment decision and hopefully help patients and doctors make a more reasonable selection at the stage of a positive biopsy.