Prostate cancer is one of the leading causes of cancer-related morbidity and mortality among men worldwide and is characterized by substantial molecular heterogeneity and the development of therapeutic resistance. Recent advances in genome-editing technologies, particularly CRISPR-Cas systems, have expanded opportunities for precise investigation and modification of genetic and epigenetic determinants involved in prostate cancer progression. This review comprehensively describes the evolution of CRISPR-based genome-editing tools, including Cas9 nucleases, base editing, prime editing, and CRISPR interference/activation systems, and their applications in prostate cancer models. Particular emphasis is placed on androgen receptor (AR) signaling and DNA damage repair (DDR) pathways, as well as genomic alterations such as PTEN loss and TMPRSS2-ERG fusion, which represent important molecular determinants and therapeutic targets in prostate cancer. The review further examines the application of CRISPR in functional genomic screening, disease modeling, and the identification of synthetic lethal interactions that may reveal novel therapeutic vulnerabilities. Emerging therapeutic strategies, including gene correction, targeting mechanisms underlying resistance to androgen deprivation and AR-directed therapies, sensitization to chemotherapy and radiotherapy, epigenome editing, and immunotherapy engineering, are critically discussed. Advances in CRISPR delivery modalities, including viral vectors, lipid-based nanoparticles, polymeric systems, and extracellular vesicles, are also evaluated with emphasis on tumor targeting, delivery efficiency, safety, and translational challenges. Overall, CRISPR-based technologies show considerable potential to support precision oncology in prostate cancer by enabling molecularly informed therapeutic strategies and addressing treatment resistance, although challenges related to delivery, off-target effects, tumor heterogeneity, immunogenicity, and clinical translation remain to be resolved.
