Exosomal miRNAs versus circulating tumor DNA: diagnostic accuracy for early detection of recurrence post-radical prostatectomy: A narrative review.

Prostate cancer is a leading malignancy worldwide, and while radical prostatectomy is an effective treatment for localized disease, a significant proportion of patients experience biochemical recurrence. Prostate-specific antigen (PSA) remains the primary biomarker for recurrence detection, but its limitations in specificity necessitate improved surveillance tools. Liquid biopsy techniques, particularly exosomal microRNAs (miRNAs) and circulating tumor DNA (ctDNA), have emerged as promising noninvasive biomarkers for early recurrence detection. However, their comparative diagnostic accuracy remains unclear. This narrative review explores the diagnostic potential of exosomal miRNAs and ctDNA for early recurrence detection following radical prostatectomy. It examines their biological characteristics, detection methodologies, comparative diagnostic performance, and clinical challenges. Both exosomal miRNAs and ctDNA hold significant potential for the early detection of prostate cancer recurrence post-radical prostatectomy. However, the lack of standardized protocols and the variability in current studies limit definitive conclusions about their relative accuracy. Future large-scale, prospective studies are necessary to validate their clinical utility and establish guidelines for their integration into routine surveillance. A multi-biomarker approach combining exosomal miRNAs, ctDNA, and PSA may provide the most effective strategy for personalized prostate cancer monitoring.