• The level of miR-145 in urine EVs was significantly increased in PCa patients compared with BPH patients.• The level of miR-145 in urine EVs was significantly increased when PCa patients with GS ≥ 8 compared with GS ≤ 7.• miR-145 in UEVs combined with serum PSA (AUC = 0.863) could differentiate PCa from BPH better than PSA alone (AUC= 0.805). This evidence concerns the gene KLK3 and posterior cortical atrophy.