Abstract: Prostate cancer has a high incidence and mortality rate among men worldwide. Its high heterogeneity and evolutionary ability lead to limited effectiveness of traditional treatment methods. In recent years, with the development of technologies such as single-cell sequencing and circulating tumor DNA analysis, the complex picture of prostate cancer molecular evolution has gradually become clear. In particular, the key role of multi-gene coexistence patterns in mediating drug resistance and lineage transformation has received widespread attention. This article, from an integrated perspective, reviews the molecular mechanisms, prognostic value and synergistic effects of key altered genes in prostate cancer, and systematically explores the latest clinical progress of precision treatment strategies targeting these targets.