Extracellular vesicles as mediators of prostatic diseases: connecting function to diagnostic and therapeutic applications.

Diseases of the prostate gland, including benign prostatic hyperplasia (BPH) and prostate cancer (PCa), affect a significant proportion of men worldwide. The incidence of these diseases increases with advancing age decreased quality of life and mortality in cases of aggressive PCa. Advanced PCa shows a spectrum of disease states, including castration-resistant prostate cancer (CRPC) and therapy-resistant neuroendocrine prostate cancer (NEPC). NEPC is a highly aggressive, AR-independent state that evolves from CRPC by "lineage switching". Although the underlying cellular mechanisms have been examined extensively, the role of extracellular-mediated intercellular communication is less well understood. Emerging evidence suggests an important role of extracellular vesicles (EVs) in the pathobiology of these diseases. EVs have been shown to be critical for imparting tumor aggressiveness via inducing epithelial to mesenchymal transition (EMT), stemness and immune evasion. Understanding EV-mediated signaling that governs the progression of prostatic diseases is crucial for developing effective targeted therapies and robust biomarkers for prognosis and risk stratification. Advances in EV engineering have enabled the development of targeted exosome-based therapeutics capable of delivering drugs, biologic payloads, or immune-stimulating signals. In this article, we review our current knowledge on the role of EVs in prostatic diseases, explore their diagnostic and therapeutic applications, and outline future directions aimed at translating EV-based technologies into tools for improved clinical management.