Multimodal artificial intelligence in urologic precision oncology: from algorithm to translational medicine (a systemized narrative review)

Precision oncology in urology increasingly depends on integrating heterogeneous data, including multiparametric imaging, histopathology, genomics, and clinical variables. Multimodal artificial intelligence (AI) offers a unified framework to manage this complexity, supporting refined risk stratification, personalized treatment decisions, and informed patient counseling. This narrative review examines applications of multimodal AI in prostate, bladder, and kidney cancers. Beyond listing individual tools, we emphasize how synergistic data fusion enhances the validation of diagnostic and prognostic performance. Clinical advances include more accurate tumor delineation on multiparametric MRI and predictive modeling of functional outcomes after surgery, underscoring the translational potential of these systems. However, major barriers hinder clinical adoption. Prospective validation remains scarce, data harmonization across institutions are limited, and the opaque nature of many algorithms fuels skepticism among clinicians. These factors collectively restrict the integration of multimodal AI into routine clinical practice. Closing this gap requires standardized data curation, development of interpretable and transparent models, and the design of collaborative human-AI workflows. Ultimately, successful translation will depend not only on technical progress but also on redefining trust and expertise in urologic oncology, ensuring that algorithmic insights are meaningfully aligned with bedside decision-making.