Metastatic prostate cancer remains an incurable lethal disease. Studies indicate that prostate cancer accumulates genomic changes during disease progression and displays the highest levels of chromosomal instability (CIN) across all types of metastatic tumours. CIN, which refers to ongoing chromosomal DNA gain or loss during mitosis, and derived aneuploidy, are known to be associated with increased tumour heterogeneity, metastasis and therapy resistance in many tumour types. Paradoxically, high CIN levels are also proposed to be detrimental to tumour cell survival, suggesting that cancer cells must develop adaptive mechanisms to ensure their survival. In the context of prostate cancer, studies indicate that CIN has a key role in disease progression and might also offer a therapeutic vulnerability that can be pharmacologically targeted. Thus, a comprehensive evaluation of the causes and consequences of CIN in prostate cancer, its contribution to aggressive advanced disease and a better understanding of the acquired CIN tolerance mechanisms can translate into new tumour classifications, biomarker development and therapeutic strategies.

转移性前列腺癌仍然是一种无法治愈的致命疾病。研究表明，前列腺癌在疾病进展过程中会积累基因组变化，并在所有类型的转移性肿瘤中表现出最高水平的染色体不稳定性（CIN）。 CIN 是指有丝分裂过程中持续的染色体 DNA 增加或丢失，以及衍生的非整倍性，已知与许多肿瘤类型的肿瘤异质性、转移和治疗耐药性增加有关。矛盾的是，高 CIN 水平也被认为不利于肿瘤细胞的存活，这表明癌细胞必须发展适应性机制以确保其存活。在前列腺癌的背景下，研究表明 CIN 在疾病进展中发挥着关键作用，并且还可能提供可药理学靶向的治疗脆弱性。因此，对前列腺癌中 CIN 的原因和后果的全面评估、其对侵袭性晚期疾病的贡献以及对获得性 CIN 耐受机制的更好理解可以转化为新的肿瘤分类、生物标志物开发和治疗策略。