Prostate cancer (PCa) is a heterogeneous disease with regard to molecular alterations and clinical course. The investigation of genetic alterations associated with PCa pathogenesis is highly challenging. Genome-wide analyses and epidemiological studies have identified only a handful of candidate genes possibly associated with hereditary or sporadic PCa. Cancer cells often rely for survival on common biochemical pathways such as enhanced anaerobic glycolysis and lipogenesis. The lipogenic enzyme fatty acid synthase seems to play a crucial part in PCa by conferring growth and survival advantages to cancer cells. We summarize the current understanding of the molecular events in PCa, and highlight the importance of altered lipid metabolism in the development and progression of prostate malignancy.