DNA methylation alterations in prostate cancer: from diagnosis to treatment

Epigenetics, particularly DNA methylation, plays a crucial role in gene activation and deactivation. Indeed, modification of this pathway has been well described as promoter of cancer development in many settings. Hypermethylation of CpG islands has also been described as a significant epigenetic alteration in prostate cancer (PCa), being associated with gene silencing and tumour progression. Key studies have shown that specific genes, such as GSTP1, APC, and RARb2, exhibit significant epigenetic alterations in PCa, with their methylation profiles showing potential utility as biomarkers in the diagnostic setting. Furthermore, comprehensive methylation analyses have identified numerous differentially methylated CpGs and relative molecular pathways associated with PCa carcinogenesis and progression, thus enhancing the understanding of its molecular underpinnings. Finally, therapies targeting DNA methylation, such as DNA methyltransferases (DNMTs) inhibitors, show potential in overcoming drug resistance in advanced PCa treatment. Consequently, dissecting epigenetic mechanisms, and in particular DNA methylation, is fundamental for understanding PCa carcinogenesis, providing valuable insights for clinical decisions and development of targeted therapies. Given the above premises, this review aims to provide an overview of the role of DNA methylation aberrations in PCa, highlighting current and future directions for exploring the epigenetic landscape to better understand the origins and progression of this disease.