PD-L1 expression on tumor-derived EVs is associated with immune evasion (Ricklefs et al., 2018), and in prostate cancer patients, large EVs, or “large oncosomes,” carry most of the ctDNA in plasma (Vagner et al., 2018; Zijlstra and Di Vizio, 2018), and these large prostate cancer oncosomes mediate changes in the tumor microenvironment and prostate fibroblast reprogramming, via AKT1-induced MYC activation (Minciacchi et al., 2017). Here, AKT1 is linked to neoplasm.