Microbiome-Prostate Cancer Interactions: Emerging Mechanisms, Diagnostic Opportunities and Therapeutic Strategies: A Review

Prostate cancer (PCa) is one of the most commonly diagnosed malignancies in men with incidence increasing significantly with advancing age. Prostate cancer (PCa) represents a major public health problem worldwide, with an estimated 1.4 million new diagnoses in 2022. Evidence is accumulating that the human microbiome may be important in PCa initiation, progression and response to therapy. Microbial populations colonising the gut, prostate and urinary tract may possess the ability to modulate immune responses, androgen metabolism, inflammatory signaling and epithelial homeostasis, potentially contributing to prostate carcinogenesis. Dysbiosis, referring to changes in the composition and diversity of the microbiome, has been associated with PCa, and the Bacteroidetes, Firmicutes, and Proteobacteria phyla have been frequently studied in relation to disease risk and progression. Furthermore, metabolites derived from microbiota, such as short-chain fatty acids, bile acid derivatives and other bioactive molecules, may modulate tumor biology by affecting immune pathways, inflammation, hormonal signaling, and epigenetic mechanisms. Recent advances in metagenomic, metabolomic and multi-omics technologies have provided new opportunities for the identification of microbiome-associated biomarkers for PCa detection, risk stratification and treatment monitoring. This review provides an overview on current understanding of the microbiome–PCa relationship with a focus on microbial dysbiosis, molecular mechanisms, emerging diagnostic applications and microbiome-targeted therapeutic approaches. It also discusses the current limitations, research gaps, and future perspectives of microbiome-based approaches for precision Pca management.