Prostate carcinoma is the most common non-cutaneous malignancy in men in developed countries and the incidence has been steadily rising in the developing countries. Active research in recent years has led to tremendous progress in our understanding of the biology and genetics, and marked improvement in diagnosis and treatment of prostate cancer. Gleason grading has remained as the cornerstone for management of patients with prostate cancer. However, the grading system has continuously evolving since its inception in response to changes in the clinical practice of diagnosis and treatment of prostate cancer. The modification of Gleason grading system implemented by the International Society of Urological Pathology in 2005 has profoundly changed the way prostate cancer is graded and consequently how patients are managed. Several prostate cancer histological types with distinct clinical and pathological features have been rediscovered or redefined. Finally, elucidations of the molecular and genetic mechanism helps not only better understand the pathogenesis of prostate cancer, but also identify biomarkers for improved diagnosis, risk stratification and clinical management. This article briefly reviews the most recent advances in the Gleason grading system, new histological types and molecular genetics of prostate cancer.