Why Has Prostate Cancer Research Lagged Behind? Advocacy, Biology, and the Road Ahead.

Prostate cancer is the second most common malignancy in men worldwide and a leading cause of cancer-related mortality, yet the trajectory of its research has consistently lagged behind cancers of comparable burden. This Perspective argues that the persistent gap is not primarily a consequence of biological difficulty, but the compounded product of structural forces: a late and fragmented patient advocacy movement shaped by stigma and norms of masculinity; sustained disparities in public research funding; decades of dependence on inadequate preclinical models that poorly recapitulate the human tumor immune microenvironment; and a persistent underrepresentation of the populations most affected by aggressive disease - men of African descent and those in low- and middle-income countries. These forces have reinforced one another and carry measurable biological consequences, including delayed advances in immunotherapy and an impoverished understanding of the cold tumor immune phenotype that defines the disease. Drawing on preliminary data from an ongoing prospective cohort at a reference cancer center in Central-West Brazil, we illustrate how structural inequity translates into advanced disease at the point of care and propose that closing this gap requires not only scientific innovation, but a fundamental recognition that the sociology of disease research is as consequential as its biology.