Abstract

Prostate cancer is a prevalent malignancy affecting men worldwide, contributing significantly to morbidity and mortality rates. Despite advances in treatment, many patients experience disease progression, treatment resistance, and metastasis due to the complex interplay within the tumor microenvironment (TME). The TME consists of various cellular and non-cellular components, including cancer-associated fibroblasts (CAFs), immune cells, endothelial cells, and the extracellular matrix (ECM). CAFs play a crucial role in reshaping the TME by secreting growth factors, cytokines, and remodeling enzymes that enhance tumor proliferation and survival. Immune cells contribute to immune evasion and create an immunosuppressive environment, limiting the effectiveness of conventional therapies. Angiogenesis, facilitated by endothelial cells within the TME, supports tumor vascularization and provides a constant supply of nutrients and oxygen. The ECM undergoes continuous remodeling, further facilitating cancer progression. This review explores emerging anti-stromal therapeutic strategies aimed at disrupting these critical stromal components within the TME of prostate cancer. It highlights the promise of targeting CAFs, modulating the immune landscape, inhibiting angiogenesis, and remodeling the ECM to prevent metastasis. Future research should focus on innovative combination therapies that integrate anti-stromal strategies with conventional treatments to improve patient outcomes and develop more effective interventions. Keywords: Prostate cancer, tumor microenvironment, anti-stromal therapies, cancer-associated fibroblasts, angiogenesis, immune modulation

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