Background: Visceral metastases are known to occur in advanced prostate cancer, usually when the tumour is resistant to androgen deprivation and, have worse outcomes regardless of therapies. Objective: To analyse genomic alterations in tumour samples according to their lymphatic, bone and visceral metastatic stages and overall survival. Design, Setting, and Participants: We selected 200 patients with metastatic prostate cancer. Genomic profiling of 111 genes and molecular signatures (Homologous recombination deficiency: HRD; Microsatellite instability: MSI and Tumour burden mutation: TMB) was performed with the MyChoice™ test (Myriads Genetics, Inc). Outcome Measurements and Statistical Analysis: Association between genomic profiles and visceral metastatic evolution was evaluated using logistic regression. Kaplan-Meier and Cox proportional hazards analyses were used for analyses of early death.Results and limitations: 173 (87%) genomic profiles were obtained. Eighty-four (49%) patients died during the follow-up period (median duration = 76 months). TP53 was the most frequently mutated gene, followed by FANC genes, including BRCA2, and those of the Wnt-pathway (APC/CTNNB1). TP53 gene mutations were more frequent in patients of European (42%) than African (16%) ancestry. An HRD score >25 was predictive of FANC genes mutations. The mutational status of TP53 (p<0.001) and APC (p=0.002) genes were significantly associated with the risk of visceral metastases. The mutational status of CTNNB1 (p=0.001), TP53 (p=0.015), BRCA2 (p=0.027), and FANC (p=0.005) genes were significantly associated with an earlier age at death. The limitations are the retrospective study design based on a selection of genes and, the low frequency of certain molecular events. Conclusion: Mutations in the TP53 gene and genes (APC/CTNNB1) related to the Wnt-pathway are associated with metastatic visceral dissemination and early death. These genomic alterations could be considered as markers to identify prostate cancer patients at high risk of life-threatening disease who might benefit from more intensified treatment or new targeted therapies.Patient summary: In this report, we evaluated relationships between genomic profiles (gene mutations and molecular signatures) of tumour samples from patients with metastatic prostate cancer and early death. We found that mutations of specific genes, notably TP53 and APC/CTNNB1 related to the Wnt-pathway, are associated with visceral metastatic progression and an earlier age at death.