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Exosomes act as key intercellular communication mediators with dual functions in prostate cancer pathogenesis and treatment: they can promote EMT, angiogenesis, tumor microenvironment remodeling, metastasis, immune evasion, and therapy resistance, while also enabling diagnostic biomarkers for noninvasive liquid biopsy and engineered therapeutic delivery. 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Immunol. 17:1748272 .  \ndoi: 10.3389/fimmu.2026.1748272  \nCOPYRIGHT  \n© 2026 Yu, Zhou, Wei, Wu, Fan, Ran and Zhang. This is an open-access article distributed under the terms of the  \nCreative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nThe dual roles of exosomes in prostate cancer: mechanisms in tumorigenesis and avenues for clinical translation  \nMingyun Yu 1, Dan Zhou 1, Huijie Wei 1, Tong Wu 1, Jiahong Fan 2, Guanghe Ran 3* and Chong Zhang 1*  \n1 Department of Pathology, Chongqing University Fuling Hospital, Chongqing, China, 2 Binhai New Area Hospital of Traditional Chinese Medicine (TCM), Fourth Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China, 3Chongqing Changshou Traditional Chinese Medicine Hospital, Chongqing, China  \nProstate cancer (PCa) management remains challenged by tumor heterogeneity, unpredictable progression, and limitations in early detection, driving demand for innovative biological insights. As pivotal mediators of intercellular communication, exosomes exhibit dualistic roles in PCa pathogenesis and therapy. While acting as ‘foes’ by facilitating epithelial-mesenchymal transition (EMT), angiogenesis, tumor microenvironment formation, metastasis, immune evasion, and therapy resistance, they concurrently serve as ‘friends ’ through their diagnostic and therapeutic potential. Exosome-derived biomarkers enable noninvasive liquid biopsy for early diagnosis, risk stratification, and treatment monitoring. Moreover, engineered exosomes function as targeted drug carriers, delivering precision therapeutics to overcome treatment barriers. This review systematically examines exosomal biogenesis, isolation methodologies, and their bidirectional regulation in PCa progression, while exploring emerging diagnostic and therapeutic applications to advance exosome-mediated precision oncology.  \nKEYWORDS  \ncancer, clinical application, exosomes, mechanism, prostate cancer  \n1 Introduction  \nProstate cancer (PCa) ranks as the second most prevalent malignancy and fifth leading cause of cancer mortality among males globally, posing a significant clinical challenge for prevention and treatment (1) . Early-stage localized PCa can be effectively managed with surgery or radiation therapy, leading to favorable prognoses. However, once the disease progresses to advanced metastatic or castration-resistant stages (Castration-Resistant Prostate Cancer, CRPC), treatment options become significantly limited, and patient survival is severely compromised (2) . Investigating the underlying mechanisms of PCa development, metastasis, and drug resistance is crucial for developing novel diagnostic and therapeutic strategies and improve the prognosis of patients (3) . Accumulating evidence underscores exosomes—critical intercellular mediators—as pivotal yet complex regula","cbCaia4j5bV6Pnzl","https://ap.wps.com/l/cbCaia4j5bV6Pnzl","pdf",1968231,"English","# Introduction\n# Exosomes in prostate cancer pathogenesis\n## Double-edged roles of exosomes\n## Diagnostic and therapeutic potential","[{\"question\":\"What dual roles do exosomes play in prostate cancer?\",\"answer\":\"Exosomes can act as tumor-promoting “foes” by supporting EMT, angiogenesis, metastasis, immune evasion, and therapy resistance. They can also serve as “friends” by providing diagnostic biomarkers and therapeutic delivery potential.\"},{\"question\":\"How can exosome-derived biomarkers support prostate cancer diagnosis and monitoring?\",\"answer\":\"Exosome-derived biomarkers enable noninvasive liquid biopsy, supporting early diagnosis, risk stratification, and treatment monitoring.\"},{\"question\":\"Which exosome functions relate to therapy resistance in prostate cancer?\",\"answer\":\"The review links exosome-mediated communication to therapy resistance, including resistance affecting chemotherapy and targeted therapy outcomes.\"}]","The dual roles of exosomes in prostate cancer - mechanisms in tumorigenesis and avenues for clinical translation | PDF",1790135134]