Abstract <p>Prostate cancer (PCa) is the most frequently diagnosed malignancy among men and presents major clinical and socioeconomic challenges worldwide. Despite advances in early detection, imaging, and therapy, managing PCa remains complex due to disease heterogeneity, risks of overdiagnosis, and overtreatment. Digital twin (DT) technologies might represent an emerging conceptual framework aimed at supporting dynamic, patient-specific virtual modeling for personalized clinical decision-making. By integrating multimodal clinical, imaging, molecular, and physiological data, DTs can simulate disease progression, predict treatment responses, and support proactive, adaptive care. This perspective explores the conceptual framework for DT ecosystems in PCa, highlighting potential clinical impacts, infrastructural requirements, and barriers to implementation. Harnessing DTs could impact PCa management into a truly predictive, personalized, and participatory approach, improving outcomes and optimizing healthcare resource utilization globally.</p> Relevance statement <p>DT technologies may enable personalized, predictive PCa management by integrating multimodal patient data to guide diagnosis, treatment selection, and monitoring, with the potential to improve outcomes, reduce overtreatment, and optimize healthcare resource utilization</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>DTs create virtual patient models to personalize PCa care.</p> </ItemContent> <ItemContent> <p>They integrate imaging, clinical, and molecular data into one system.</p> </ItemContent> <ItemContent> <p>This approach may reduce overdiagnosis and unnecessary treatments.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>