Precision medicine that takes individual variability into account is a new way to minimize the individual variability for precise diagnosis and to establish the certain strategies of efficient therapy. Due to miniaturization sensing area, remoting detection, and flexible operation of light, fiber optics have been successfully used to develop in vitro, wearable, and implanted biosensors, exhibiting high potential in precision medicine from the diagnosis in vitro to therapy in vivo. When modified with the recognition element, the fiber optic‐based biosensor enables the point of care testing for the detection of disease biomarkers. Meanwhile, the fiber optics packaged in a needle/catheter also monitor the medical Internet of things for the continuous assessment of human health. Moreover, the light from the cladding or leaky mode in the fiber optics excites the strong photothermal effect for therapy. The fiber optic‐based biosensor addressed the drawbacks of plasmonic photothermal therapy that limited penetration depths and non‐selectivity therapy. When integrated with a photothermal agent, the fiber optic‐based biosensors provide in situ information for the diagnosis as well as specifically and efficiently kill the tumor cells in deep tissues. In this review, we summarized the advances of fiber optic‐based biosensors in the diagnosis in vitro and therapy in vivo. The challenges and prospection of the fiber optic‐based biosensor application in precision medicine were also explored in depth.