Prostate-specific EV capture with sufficient RNA yield to enable transcriptomic profiling

Abstract Prostate-specific antigen (PSA) screening has reduced prostate cancer (PCa) mortality but suffers from limited specificity, contributing to unnecessary biopsies and overdiagnosis of indolent disease. There is a critical need for biofluid-based biomarkers that improve the precision of PCa detection. Extracellular vesicles (EVs) offer a promising platform for noninvasive diagnostics, as they carry molecular cargo reflective of their tissue of origin. The ExoDx Prostate IntelliScore (EPI) test, a urine-based EV assay, is currently the only commercial EV diagnostic for clinically significant (cs)PCa, but its performance may be constrained by contamination from renal and bladder-derived EVs. To address this, we developed Exosome Diagnostics Depletion and Enrichment (EDDE), a novel immunocapture-based method for isolating prostate-derived EVs with high specificity. By targeting Prostate Specific Membrane Antigen (PSMA), we optimized EDDE to selectively enrich prostate EVs from post-DRE urine and recover sufficient RNA for transcriptomic analysis. Throughout development, we implemented a quantitative framework to track EV stoichiometry and assess depletion efficiency and yield, enabling rigorous optimization of the workflow. Our findings demonstrate that PSMA EDDE enriches prostate-specific EVs and yields RNA quantities compatible with sequencing. This platform enhances the specificity of EV-based biomarker discovery and holds promise for determining if tissue-specific EV biomarkers contribute advantages over bulk EVs.