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Prostate cancer. Prostate cancer poses a substantial clinical challenge and accounts for a large proportion of cancer-related deaths worldwide. The therapeutic landscape has undergone a large transformation in the past 5 years, resulting in improved patient outcomes. In this Seminar, we review the pathology, diagnostic strategies, and treatments for prostate cancer. Active surveillance is the preferred treatment option for patients with indolent prostate cancer. For those requiring treatment, local therapies provide effective cancer control. Systemic treatment is essential for advanced and metastatic cases, and a wide range of therapies are now available, including androgen deprivation therapy, chemotherapy, and emerging targeted agents such as lutetium-177-labelled prostate-specific membrane antigen radioligand therapy and PARP inhibitors. Considering toxicity profiles alongside patient preferences is important to facilitating shared decision making. Further research is needed to establish the most effective sequence and combination of treatments for metastatic prostate cancer.

Prostate cancer. The management of prostate cancer continues to evolve rapidly, with substantial advances being made in understanding the genomic landscape and biology underpinning both primary and metastatic prostate cancer. Similarly, the emergence of more sensitive imaging methods has improved diagnostic and staging accuracy and refined surveillance strategies. These advances have introduced personalised therapeutics to clinical practice, with treatments targeting genomic alterations in DNA repair pathways now clinically validated. An important shift in the therapeutic framework for metastatic disease has taken place, with metastatic-directed therapies being evaluated for oligometastatic disease, aggressive management of the primary lesion shown to benefit patients with low-volume metastatic disease, and with several novel androgen pathway inhibitors significantly improving survival when used as a first-line therapy for metastatic disease. Research into the molecular characterisation of localised, recurrent, and progressive disease will undoubtedly have an impact on clinical management. Similarly, emerging research into novel therapeutics, such as targeted radioisotopes and immunotherapy, holds much promise for improving the lives of patients with prostate cancer.