Artificial Intelligence in Prostate MRI: Current Evidence and Clinical Translation Challenges-A Narrative Review

Despite rapid proliferation of AI applications in prostate MRI showing impressive technical performance, clinical adoption remains limited. We conducted a comprehensive narrative review of literature from January 2018 to December 2024, examining AI applications in prostate MRI with emphasis on real-world performance and implementation challenges. Among 200+ studies reviewed, AI systems achieve 87% sensitivity and 72% specificity for cancer detection in research settings. However, external validation reveals average performance drops of 12%, with some implementations showing degradation up to 31%. Only 31% of studies follow reporting guidelines, 11% share code, and 4% provide model weights. Seven real-world implementation studies demonstrate integration times of 3-14 months, with one major center terminating deployment due to unacceptable false positive rates. The translation gap between artificial and clinical intelligence remains substantial. Success requires shifting focus from accuracy metrics to patient outcomes, establishing transparent reporting standards, developing realistic economic models, and creating appropriate regulatory frameworks. The field must combine methodological rigor, clinical relevance, and implementation science to realize AI's transformative potential in prostate cancer care.