Background/Aim: Diagnostic and prognostic biomarkers in localized prostate cancer (PC) are insufficient. Treatment stratification relies on prostate-specific antigen, clinical tumor staging and International Society of Urological Pathology (ISUP) grading, whereas molecular profiling remains unused. Integrins (ITG) have an important function in bidirectional signaling and are associated with progression, proliferation, perineural invasion, angiogenesis, metastasis, neuroendocrine differentiation, and a more aggressive disease phenotype in PC. However, ITG subunit expression in localized PC and their utility as prognostic biomarkers has not yet been analyzed. This study aimed to fill this gap and provide a comprehensive overview of ITG expression as well as ITG utility as biomarkers. Patients and Methods: The Cancer Genome Atlas (TCGA) and the Memorial Sloan Kettering Cancer Center (MSKCC) prostate adenocarcinoma cohorts were analyzed regarding ITG expression in correlation to ISUP, N-and American Joint Committee on Cancer (AJCC) stage and were correlated with disease-free survival (DFS). Statistical tests used included the Mann-Whitney U-test, logrank test and uni-and multivariable cox regression analyses. Results: After grouping for ISUP (1 and 2 vs. 3-5), N0 vs. N1 and AJCC stage (≤2 vs. ≥3), multiple ITGs showed significant expression differences. The most consistent results were observed for ITGα4, ITGαX, ITGα11, ITGβ2 and ITGα2. In multivariable cox regression, ITGα2, ITGα10, ITGαD, ITGαB2 (TCGA), ITGα11 and ITGβ4 (MSKCC) were independent predictors of DFS. Conclusion: The utility of ITGs as PC biomarkers was herein shown.Prostate cancer (PC) is the second most common cancer in men and ranks fifth in cancer-related mortality worldwide (1). The introduction of prostate-specific antigen (PSA) screening led to a significant reduction of mortality over the last decades. Next to PSA, current PC screening and treatment decision/stratification is based on digital rectal examination (DRE) and prostate biopsy with or without magnetic resonance imaging (MRI) guidance (2). However, there are several limitations in detection and risk stratification. PSA is organ-, but not tumor-specific. This explains why PC detection biopsy is only positive in around 25% for patients with PSA 2-10 ng/ml (3). False-positive results above thresholds (e.g., in patients with benign prostatic hyperplasia or prostatitis) limit the accuracy. Another critique on the use of PSA screening in PC detection is overdiagnosis and subsequently overtreatment of patients, in which an insignificant PC would never surface during the patient lifespan (3). Additionally, biopsy undersampling may lead to underestimation of the true tumor grade and upgrading after radical prostatectomy (RP) (4-6). Once diagnosed, PC shows an enormous biological heterogeneity: Even though some patients die of metastatic disease within a few years, others can live for 10-20 years with an organ-confined disease (7). This might be due to genomic diversity-like differences in the tr...