Cancer Genetics and Epigenetics, 2025, Vol.13, No.1, 21-31 http://medscipublisher.com/index.php/cge 21 Feature Review Open Access Emerging Molecular Pathways in Prostate Cancer Development and Their Therapeutic Implications Liting Wang Hainan Institute of Biotechnology, Haikou, 570206, Hainan, China Corresponding email: liting.wang@hibio.org Cancer Genetics and Epigenetics, 2025, Vol.13, No.1 doi: 10.5376/cge.2025.13.0003 Received: 10 Dec., 2024 Accepted: 16 Jan., 2025 Published: 29 Jan., 2025 Copyright © 2025 Wang, This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Preferred citation for this article: Wang L.T., 2025, Emerging molecular pathways in prostate cancer development and their therapeutic implications, Cancer Genetics and Epigenetics, 13(1): 21-31 (doi: 10.5376/cge.2025.13.0003) Abstract This study explored the clinical variability of prostate cancer, ranging from indolent to metastatic and invasive forms. The transformation from hormone-sensitive prostate cancer (HSPC) to castration-resistant prostate cancer (CRPC) constitutes a major therapeutic obstacle. At this stage, traditional androgen suppression therapy (ADT) loses its efficacy and new molecular mechanisms need to be explored. This study also explored key progression mechanisms such as the AR signal cascade, the PI3K/Akt/mTOR axis, the Wnt/β-catenin network, and the DNA damage response pathway. The epigenetic regulation, the function of non-coding RNA (miRNA) and the dynamics of the tumor microenvironment were systematically analyzed. This study also emphasizes the continuously evolving precision oncology methods and targeted intervention measures, laying the foundation for customized treatment strategies to improve clinical outcomes. Keywords Prostate cancer; Androgen receptor signaling; PI3K/Akt/mTOR pathway; Tumor microenvironment; Precision medicine 1 Introduction Prostate cancer is one of the most common malignant tumors in the male population. In developed regions of Europe and America, the fatality rate of this disease ranks second among male malignant tumors, only after lung cancer (Gonzalgo and Isaacs, 2003; Testa et al., 2019). The significant heterogeneity of clinical manifestations increases the complexity of diagnosis and treatment: some cases show rapid metastasis characteristics, while others maintain a slow progression pattern. It is worth noting that when the tumor progresses from the hormone-sensitive stage to the castration-resistant stage, it indicates that traditional hormone therapy has failed and the disease has entered a difficult-to-treat stage. This key pathological turning point poses a severe test for clinical management (Pisano et al., 2020; Maekawa et al., 2024). Clarifying the intrinsic molecular regulatory mechanisms and developing new therapeutic approaches are the core demands for responding to disease evolution (Ku et al., 2019). In-depth research on the molecular characteristics of tumors is the basis for building a precision medical system. Modern medical research has discovered core gene variations, including mutations in DNA repair genes (such as BRCA2, ATM) and disorders in androgen pathways, which significantly alter the disease progression (Antonarakis, 2022; Grypari et al., 2023; Maekawa et al., 2024). These breakthroughs have promoted the research and development of innovative therapies: The combination therapy of PARP inhibitors for DNA repair disorders and the immunotherapy methods for patients with genetic abnormalities have been put into clinical application (Mateo et al., 2017; Ku et al., 2019; Grypari et al., 2023). The mechanism analysis of important signaling pathways such as PI3K/Akt and Wnt provides new ideas for clinical decision-making (Pisano et al., 2020; Koushyar et al., 2022). These advancements contribute to the construction of an individualized diagnosis and treatment system and achieve precise treatment guided by molecular characteristics (Wang et al., 2023; Maekawa et al., 2024). This study will explore the core molecular mechanisms of prostate cancer development and their translational value. Based on a review of recent research progress, it will focus on analyzing the interactions among gene variations, epigenetic regulation, tumor microenvironment and signal networks. This study assesses the application potential of existing and novel targeted therapies and clarifies the guiding value of molecular typing
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