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Figure 2. Comparative EV-associated resistance themes across bladder cancer, RCC and prostate cancer. Although this review focuses on bladder cancer, selected studies in RCC and prostate cancer provide comparative insights into the role of EVs in treatment adaptation. In RCC, representative evidence supports EV-associated TKI resistance mediated by lncARSR, IGFL2-AS1 and miR-31-5p, as well as hypoxia-associated vascular adaptation. In bladder cancer, EV studies support chemotherapy-associated adaptation, BCG- and immune-checkpoint blockade-associated immune modulation and the emerging role of urinary EV monitoring. In prostate cancer, EV-associated themes include AR-pathway adaptation, EV-associated AR-V7 as a biomarker of resistance to AR-targeted therapy and stromal EV-mediated crosstalk. The figure summarises representative disease-specific EV themes rather than implying equivalent levels of evidence across tumour types. Created in BioRender. Wu, Y. (2026) https://BioRender.com/rrmpdf1. EV: Extracellular vesicle; RCC: renal cell carcinoma; TKI: tyrosine kinase inhibitor; BCG: Bacillus Calmette–Guérin; AR: androgen receptor; ICI: immune-checkpoint inhibitor; CAF: cancer-associated fibroblast.