Emad Rajih, Abdulaziz Bakhsh, Walaa Borhan, Saeed Awad M. Alqahtani
Prostate cancer management has long been challenged by the limitations of traditional screening tools like PSA testing, which contribute to significant rates of overdiagnosis and overtreatment. While advanced imaging such as multiparametric MRI (mpMRI) has improved the diagnostic pathway, the integration of Artificial Intelligence (AI) is now catalyzing a paradigm shift across the entire continuum of care. This comprehensive review details the transformative role of AI in prostate cancer. In diagnostics, deep learning algorithms enhance the interpretation of mpMRI by improving lesion detection, segmentation, and risk stratification, thereby reducing unnecessary biopsies. In digital pathology, AI provides automated and consistent Gleason grading, minimizing inter-observer variability and refining prognostication. In the therapeutic domain, AI is crucial for personalizing treatment by streamlining radiotherapy planning through automated contouring, predicting patient outcomes and toxicity, and enabling the development of adaptive therapy strategies for advanced disease. Multimodal AI models that synthesize imaging, biomarker, and clinical data are creating robust predictive tools for superior clinical decision support. Despite formidable challenges related to prospective validation, data equity, and regulatory approval, AI is paving the way for a new standard of care characterized by greater precision, efficiency, and personalization.