The reporting quality of systematic reviews and meta-analyses is fundamental to the value of evidence in evidence-based medicine. As the internationally endorsed standard, the PRISMA statement and its extensive suite of extensions are crucial for standardizing reporting and enhancing transparency. However, a comprehensive, systematic understanding of its entire framework and profound challenges remains inadequate in the academic community. This review aims to systematically delineate and deeply analyze the complete PRISMA reporting guideline framework, evaluate its application value, uncover its implementation challenges, and forecast its future development directions. This paper traces PRISMA's evolution from its predecessor, QUOROM, to PRISMA 2020, highlighting key shifts in its core principles. It systematically constructs a multi-dimensional framework for the PRISMA family for the first time, categorizing its extensions by foundational versions, study design/analysis types, reporting process stages, disciplinary domains, and specific areas of focus, complemented by a forward-looking analysis of tools currently under development. The review delves into the deep-seated challenges in PRISMA's implementation, including misconceptions, inconsistent application, cross-disciplinary adaptability, and methodological limitations. It proposes that its future lies in balancing standardization with flexibility, enhancing globalized application, and deeply integrating with emerging technologies like artificial intelligence. The PRISMA framework has evolved from a mere reporting checklist into a core methodological architecture that promotes standardization throughout the entire evidence synthesis lifecycle. The continuous optimization and proper application of this framework are of critical theoretical and practical significance for enhancing the overall quality and impact of evidence synthesis research globally.