A systematic review of AI as a digital twin for prostate cancer care

Artificial Intelligence (AI) and Digital Twin (DT) technologies are rapidly transforming healthcare, offering the potential for personalized, accurate, and efficient medical care. This systematic review focuses on the intersection of AI-based digital twins and their applications in prostate cancer pathology. A digital twin, when applied to healthcare, creates a dynamic, data-driven virtual model that simulates a patient's biological systems in real-time. By incorporating AI techniques such as Machine Learning (ML) and Deep Learning (DL), these systems enhance predictive accuracy, enable early diagnosis, and facilitate individualized treatment strategies for prostate cancer. This review systematically examines recent advances (2020-2025) in AI-driven digital twins for prostate cancer, highlighting key methodologies, algorithms, and data integration strategies. The literature analysis also reveals substantial progress in image processing, predictive modeling, and clinical decision support systems, which are the basic tools used when implementing digital twins for prostate cancer care. Our survey also critically evaluates the strengths and limitations of current approaches, identifying gaps such as the need for real-time data integration, improved explainability in AI models, and more robust clinical validation. It concludes with a discussion of future research directions, emphasizing the importance of integrating multi-modal data with Large Language Models (LLMs) and Vision-Language Models (VLMs), scalability, and ethical considerations in advancing AI-driven digital twins for prostate cancer diagnosis and treatment. This paper provides a comprehensive resource for researchers and clinicians, offering insights into how AI-based digital twins can enhance precision medicine and improve patient outcomes in prostate cancer care.