Urothelial Carcinoma and the Potential Clinical Application of Urinary Extracellular Vesicles: Current Status and Prospects

Background: Recently, urinary extracellular vesicles (uEVs) have emerged as promising biomarkers for early diagnosis, prognosis, and treatment monitoring in urothelial carcinoma (UC). uEVs encapsulate nucleic acids, proteins, and other bioactive molecules that reflect the tumor microenvironment, potentially offering a non-invasive approach for real-time cancer assessment. Methodology: A comprehensive literature review was conducted, focusing on recent studies evaluating uEVs in UC, particularly regarding their molecular contents, such as microRNA (miRNA), long non-coding RNAs (lncRNAs), circular RNA (circRNA), messenger RNA (mRNA), and proteins. Studies that assessed the clinical utility of uEVs for diagnosis, prognosis, and individualized treatment guidance in UC were emphasized. Results: Studies have identified a variety of EV-RNAs and EV-proteins as potential diagnostic and prognostic biomarkers, with some showing promise for treatment response. However, challenges in validation, limited cohort sizes, and inconsistent findings have hindered their clinical application. Liquid biopsies using uEVs are advancing UC precision medicine by improving diagnostic accuracy, identifying molecular subtypes, and potentially predicting therapeutic responses. Conclusions: UEVs are promising for UC management, offering a minimally invasive, accessible source of biomarkers for diagnosis, prognosis, and treatment monitoring. Although further research and large-scale validation are needed, the integration of uEVs into clinical practice has the potential to transform UC patient care by providing precise personalized management strategies. Continued advances in EV research and biomarker discovery may ultimately lead to more effective targeted UC therapies.