Therapeutic Potential of miRNAs in Prostate Cancer: From Mechanisms to Targeted Therapy and Clinical Applications

Background/Objectives: Prostate cancer remains one of the leading causes of cancer-related morbidity and mortality among men worldwide, highlighting the need for more effective therapeutic strategies. MicroRNAs (miRNAs), small non-coding RNAs that regulate post-transcriptional gene expression, have emerged as promising therapeutic targets because they simultaneously modulate multiple signaling pathways involved in tumor progression, metastasis, androgen receptor signaling, and treatment resistance. Methods: This narrative review synthesizes current evidence on miRNA-based therapeutic strategies for prostate cancer, including miRNA replacement therapy, inhibition of oncogenic miRNAs, and emerging delivery approaches. Results: Particular emphasis is placed on key miRNAs with therapeutic potential, including miR-34a, miR-145, miR-205, miR-146a, miR-141, miR-21, miR-221/222, miR-375, and miR-181a, together with their underlying molecular mechanisms and preclinical evidence. In addition, the review discusses the major challenges limiting clinical translation, including context-dependent miRNA biology, efficient delivery, and safety considerations. Finally, future perspectives on biomarker-guided patient selection, optimized delivery technologies, and combination therapeutic strategies are highlighted to support the development of clinically applicable miRNA-based therapies. Conclusions: Overall, miRNA-based therapeutics represent a promising complementary approach for precision medicine in prostate cancer, although further translational and clinical validation is required before routine clinical implementation.