There is no single cause of prostate cancer. The cancer originates in the epithelial cells of the glandular elements of the prostate. As with most cancers defects in the DNA of the cell are central to the development of prostate cancer. Multiple DNA defects are required for cancer to develop. This multi-step process takes place over time. Some defects can be inherited, while others are acquired during the patient's lifetime.

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Prostate cancer is exceedingly rare before the age of 40, but 1 in 8 men between the ages of 60 and 80 years suffer from the disease. 9% of all prostate cancers are caused by a genetic susceptibility, probably inherited via chromosome 1. These genetically related cancers tend to present at a relatively younger age. Testosterone and its active metabolite dihydrotestosterone are essential for prostate cancer to develop, but does not actually cause prostate cancer. Men who are castrated at a young age do not develop prostate cancer.

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