The role of the human microbiome in prostate cancer: a systematic review from diagnosis to treatment.

In 30 seconds

This systematic review assessed human microbiome associations with prostate cancer (PC) diagnosis, prognosis, and treatment response. Of 810 records screened, 42 controlled or observational studies met inclusion criteria. Microbial profiles differed between PC and controls, and urinary microbiota showed diagnostic sensitivity of 58-82%. Gut Betaproteobacteria enrichment was associated with earlier castration-resistant progression (HR 1.8, 95% CI 1.3-2.5); treatment-related microbial changes were also linked to resistance and adverse outcomes. The authors conclude that microbiome effects may be direct or gut-mediated, but prospective studies are needed to establish causality and clinical utility.

Key findings

• Mycoplasma genitalium and Staphylococcus spp. were enriched in prostate tumors by 3.1- and 2.7-fold, respectively.
• Urinary microbiota had reported diagnostic sensitivity of 58-82%, with variability influenced by sampling methods.
• Gut Betaproteobacteria enrichment predicted earlier castration-resistant progression (5.2 months; HR 1.8, 95% CI 1.3-2.5).
• ADT-associated dysbiosis, including Klebsiella overgrowth, was linked to a 2.1-fold risk of resistance.

Why it matters

The review brings together evidence that microbial patterns may relate to PC detection, progression, and response to treatment. This offers a potential avenue for understanding heterogeneity and resistance, while highlighting that findings span different microbial sites and sampling approaches. The reported associations are not yet sufficient to establish causality or support routine microbiome-based decisions.

What to keep in mind

The included evidence comprised controlled and observational studies, and the authors state that prospective trials are needed to validate causality. Sampling methods also contributed to variability in diagnostic findings.