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While acting as \u2018foes\u2019 by facilitating epithelial-mesenchymal transition (EMT), angiogenesis, tumor microenvironment formation, metastasis, immune evasion, and therapy resistance, they concurrently serve as \u2018friends\u2019 through their diagnostic and therapeutic potential. Exosome-derived biomarkers enable non-invasive 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.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1748272","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T07:09:45Z","timestamp":1770793785000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["The dual roles of exosomes in prostate cancer: mechanisms in tumorigenesis and avenues for clinical translation"],"prefix":"10.3389","volume":"17","author":[{"given":"Mingyun","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Pathology, Chongqing University Fuling Hospital","place":["Chongqing, 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