Abstract: Prostate cancer, one of the most common male malignancies in the world, seriously threatens the health of middle-aged and elderly men. The clinical manifestations and prognosis of prostate cancer patients have individual differences. Most low-risk patients have a slow disease course and a low risk of death, while intermediate- and high-risk patients have a poor prognosis and a high risk of death. Current studies have shown that prostate cancer genes have complex genetic heterogeneity associated with clinical manifestations and somatic mutation is an important part of prostate cancer genome variations. With the development of high-throughput sequencing technology, related research is increasing. This article reviews the research progress on somatic mutations in prostate cancer and treatment to provide reference for prognosis prediction and drug treatment of the disease.