Prostate cancer is one of the most prevalent malignancies for men world wide. However, only a small fraction of prostate cancer cases are metastasizing and life-threatening. Even though the detection rate of prostate cancer has been steadily increased in the last two decades due to implementation of PSA screening, it is still not clear what factors govern its clinical outcomes. In this review, we will discuss several recent pathological advances that might contribute to the progression of prostate cancer. In addition, this review will cover a brief overview on conventional morphological evaluation of prostate cancer differentiation.