Additionally, genetic alterations in pathways such as PTEN/PI3K/AKT, DNA damage repair (e.g., BRCA1/2), and TMPRSS2-ERG fusions further enhance tumor aggressiveness and confer resistance to conventional hormone therapies (Waarts et al., 2022; Berger and Mardis, 2018). This evidence concerns the gene PIK3CA and neoplasm.