Effective strategies for the accurate diagnosis and efficacious management of antisocial personality disorder (ASPD) in the US prison population remain elusive. This deficit comes at great cost, given higher rates of disciplinary infractions, including violent and nonviolent misconduct, as well as recidivism in incarcerated individuals with ASPD. Various prognostic factors, including age, symptom onset in childhood or adolescence, presence of psychopathic features, and length of incarceration, may guide systematic risk stratification and, thus, more appropriate resource utilization to address the behavioral problems presented by these patients in forensic settings. Insufficient evidence supports either psychological or pharmacological interventions in treating ASPD, but recent literature highly recommends pharmacotherapy to treat comorbidities as well as the most problematic aspects of the condition for prison and general populations alike, namely aggression and impulsivity. Due to the limited pharmacotherapy available in the US prison system, incarcerated antisocial personalities face additional obstacles to optimal treatment, often resulting in poorer outcomes and a significant psychosocial burden on the prison population. Collaborative, interprofessional, and team-based approaches are the standard of care upon which optimal treatment of incarcerated ASPD patients may be based.