• Urinary EV miR-2909 distinguishes PCa from BCa.• Urinary EV miR2909 correlates with the severity (GS) of PCa in all its forms.• Urinary EV miR-2909 revealed a better diagnostic potential for PCa than either PSA or miR-615-3p. This evidence concerns the gene KLK3 and posterior cortical atrophy.