<p>Prostate cancer is a significant global health concern and the second leading cause of death among males. It is known to affect nearby stromal cells. Exosomes assist these stromal cells in supporting cancer growth and spread. They also contribute to the initiation and dissemination of cancer, as well as to the development of drug-resistant cancer cells. The recent discovery of microRNAs (miRNAs) has drawn attention from cancer researchers due to their role in regulating gene expression. Circulating exosomes may carry extracellular miRNAs that serve as prognostic indicators for cancer. There is an urgent need for new biomarkers to improve prostate cancer diagnosis. Recent studies suggest that serum exosomal miRNAs could be effective, noninvasive biomarkers for specific conditions. Exosomal miRNA has emerged as a reliable biomarker for diagnosing and treating prostate cancer. It may also serve as a potential therapy for the disease. Based on clinical and preclinical research, this review explores current knowledge about exosomal miRNAs in prostate cancer diagnosis and treatment, as well as their potential for disease monitoring. Furthermore, this analysis emphasizes the complex role of exosomal microRNAs in prostate cancer development and treatment resistance, including their impact on immune evasion, stromal cell activation, niche formation, and metabolic alterations.</p>