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Figure 3. Longitudinal EV monitoring windows in bladder cancer drug adaptation. EV-based assessment in bladder cancer can be conceptualised across three complementary clinical windows: pretreatment baseline stratification, early on-treatment EV remodelling and candidate pre-progression monitoring. Pretreatment EV profiles may support baseline risk stratification but should not be considered validated treatment-selection tools without treatment-specific validation. Early on-treatment EV trajectories may reflect pharmacodynamic response, treatment-induced injury, immune activation or emerging adaptive states. Candidate pre-progression EV changes may provide early-warning signals before overt clinical resistance, but their clinical use warrants prespecified signatures, serial sampling, source attribution and independent validation. These windows should be interpreted according to treatment context, including gemcitabine, platinum-based chemotherapy, BCG and immune-checkpoint blockade. Created in BioRender. Wu, Y. (2026) https://BioRender.com/25batum. EV: Extracellular vesicle; BCG: Bacillus Calmette–Guérin.