In this study, we illuminated that the ADSC-EVs could deliver NEAT1 into PCa cells, and NEAT1 was upregulated in PCa, and subsequent gain- and loss-of-function experiments revealed that ADSC-EVs carrying NEAT1 promote PCa progression and gemcitabine resistance in vitro and in vivo by mediating the miR-491-5p/Snail/SOCS3 axis. Here, SNAI1 is linked to posterior cortical atrophy.