Three decades of artificial intelligence in prostate cancer show technical progress while evidence of clinical benefit is still emerging

Artificial intelligence has been applied to prostate cancer for three decades, but evidence that it improves long-term patient outcomes remains limited. This narrative review traces the field chronologically from 1994 through 2025 and examines a recurring pattern of strong retrospective performance, reduced performance or uncertainty during external validation, and slow clinical adoption. Prospective studies have nevertheless reported clinically meaningful intermediate benefits, including more consistent grading, fewer unnecessary biopsies, more efficient workflows, higher detection of clinically significant cancer, and improved surgical margin status. Prostate cancer's long natural history means that survival and quality-of-life effects require longer follow-up, so their absence should not be interpreted as evidence of no clinical utility. We interpret the evidence as suggesting that translation depends on algorithm performance together with workflow fit, data standardization, infrastructure, regulation, and prospective evaluation.