The Role of Exosomes in Prostate Cancer Progression and Therapy Resistance

Background: To evaluate the role of circulating exosomes in prostate cancer progression and to investigate their association with therapy resistance and survival outcomes. Methods: A prospective observational study was conducted at DHQ teaching hospital Mardan from May 2023 to May 2024 among 82 patients with histologically confirmed prostate cancer. Demographic, clinical, and pathological data were recorded. Plasma-derived exosomes were isolated, quantified, and characterized using nanoparticle tracking analysis, transmission electron microscopy, Western blotting, and RT-qPCR. Exosomal markers including miR-21, AR-V7, and PD-L1 were correlated with disease stage, therapeutic response, and survival outcomes. Statistical analysis included chi-square tests and Kaplan–Meier survival curves. Results: Elevated exosome concentration and high expression of exosomal miR-21 were significantly associated with advanced stage and poor treatment response (p<0.05). Exosomal AR-V7 positivity correlated with resistance to androgen deprivation therapy (p=0.009), while exosomal PD-L1 expression was linked to shorter progression-free and overall survival (p<0.05). Conclusion: Exosomes play a central role in prostate cancer progression and resistance to therapy. Specific exosomal biomarkers such as AR-V7 and PD-L1 may serve as non-invasive tools for disease monitoring and prediction of treatment outcomes. Targeting exosome-mediated signaling could provide new therapeutic strategies in advanced prostate cancer