对生长、转移和耐药性发展所涉及的细胞过程的日益深入的了解使得能够开发出针对晚期前列腺癌的新治疗策略。本报告的目的是通过选定的例子向读者展示当前的进展并给出展望关于晚期前列腺癌治疗可能即将发生的变化。基于专家共识的叙述性报告，并得到 PubMed (MEDLINE) 文献检索以及美国临床肿瘤学会 (ASCO) 和欧洲肿瘤内科学会 (ASCO) 的摘要数据库的支持 (欧洲标准组织）。选择示例来说明当前的发展，但不要求完整性。雄激素受体 (AR) 信号转导途径仍然是科学兴趣的焦点。雄激素合成抑制剂和 AR 降解剂是克服 AR 突变或剪接变异介导的耐药性的有前途的新方法。抑制 AKT 或 CDK4/6 等替代信号通路的关键开关位点提供了额外的治疗选择，包括通过与 AR 信号通路紧密连接的组合策略。使用双特异性 T 细胞接合器 (BiTE) 和嵌合抗原受体 (CAR) T 细胞的新型免疫治疗策略需要更好地了解肿瘤微环境和免疫反应。新的治疗策略给我们带来了希望，我们将能够更有效地干预肿瘤晚期前列腺癌未来的病程。然而，一个主要挑战，特别是对于实施靶向治疗方法而言，可能是肿瘤进展的异质性，不仅是个体间的，而且是个人内部的。© 2023。作者获得 Springer Medizin Verlag GmbH 的独家许可，施普林格自然杂志。

An increasing understanding of the cellular processes involved in growth, metastasis and development of resistance enable the development of new treatment strategies for advanced prostate cancer.Using selected examples, the aim of this report is to present current developments to the reader and to give an outlook on possible upcoming changes in the treatment of advanced prostate cancer.Narrative report based on expert consensus, supported by a literature search in PubMed (MEDLINE) and the abstract databases of the American Society of Clinical Oncology (ASCO) and European Society of Medical Oncology (ESMO). Examples were selected to illustrate current developments without claiming completeness.The androgen receptor (AR) signal transduction pathway remains a focus of scientific interest. Androgen synthesis inhibitors and AR degraders are promising new approaches to overcome resistance mediated by AR mutations or splice variants. Inhibition of key switch sites of alternative signaling pathways such as AKT or CDK4/6 provide additional treatment options, including combinational strategies through a tight linkage with the AR signaling pathway. A better understanding of tumor microenvironment and immune response is required for novel immunotherapeutic strategies using bispecific T‑cell engagers (BiTEs) and chimeric antigen receptor (CAR) T cells.New treatment strategies give hope that we will be able to intervene even more effectively in the course of disease of advanced prostate cancer in the future. However, a major challenge, especially for the implementation of targeted treatment approaches, is likely to be the heterogeneity of tumor progression not only inter- but also intrapersonally.© 2023. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.