- Human pathology

Home > E. Pathology by systems > Reproductive system > Male genital system > Prostate > prostatic adenocarcinoma

prostatic adenocarcinoma

Friday 12 December 2003

prostate carcinomas, prostate cancer, prostatic carcinomas, prostatic adenocarcinomas; prostate adenocarcinoma


See also: prostate cancer


Prostatic adenocarcinoma shows prominent nucleoli and an increased nuclear size and N/C ratio. There is an absent basal cell layer, and glands tend to be rounded rather than tufted. Definitive features of prostatic adenocarcinoma include perineural invasion, collagenous micronodules / mucinous fibroplasia, and glomerular forms. It is negative for p63 (usually) and CK903, and positive for AMACR / racemase.


Prostate cancer (CaP) is the most commonly diagnosed malignancy and the second leading cause of cancer mortality in males in the United States. The high rate of mortality is associated with widespread metastatic disease.

In 2006, about 234,460 men in the U.S. will be diagnosed with prostate cancer and nearly 27,500 deaths can be attributed to the disease each year.

Adenocarcinoma of the prostate is common. It is the most common non-skin malignancy in elderly men. It is rare before the age of 50, but autopsy studies have found prostatic adenocarcinoma in 80% of men more than 80 years old.

Many of these carcinomas are small and clinically insignificant. However, some are not, and prostatic adenocarcinoma is second only to lung carcinoma as a cause for tumor-related deaths among males. (Bostwick et al, 2004)

Men with a higher likelihood of developing a prostate cancer (in the U.S.) include those of older age, black race, and family history. Those with an affected first-degree relative have a much greater risk. (Bostwick et al, 2004)

Prostate cancers may be detected by digital examination, by ultrasonography (transrectal ultrasound), or by screening with a blood test for prostate specific antigen (PSA).

None of these methods can reliably detect all prostate cancers, particularly the small cancers. Widespread PSA screening is not cost-effective.

Men whose life expectancy is less than 10 years not pursue prostate cancer early detection because the likelihood of benefitis outweighed by the risk of harms from treatment.

Men at higher risk for prostate cancer at earlier ages, including men of African American ancestry or a family history of prostate cancer in nonelderly relatives, should be provided the opportunity for informed decision making at an earlier age than average-risk men. (Wolf et al, 2010)


PSA is a glycoprotein produced almost exclusively in the epithelium of the prostate gland.

In the circulation PSA may be complexed to serum proteins (complexed PSA, or cPSA) or may be free (fPSA). The cPSA and fPSA together comprise total PSA (tPSA).

The tPSA is normally less than 4 ng/mL (normal ranges vary depending upon which assay is used).

A mildly increased tPSA in a patient with a very large prostate can be due to nodular hyperplasia, or to prostatitis, rather than carcinoma.

The fPSA correlates more closely with benign prostatic conditions than the tPSA.

The cPSA has a greater sensitivity for prostatic adenocarcinomas at the low ranges of elevation.

A rising tPSA is suspicious for prostatic carcinoma, even if the tPSA is in the normal range.

Transrectal needle biopsy, often guided by ultrasound, is useful to confirm the diagnosis, although incidental carcinomas can be found in transurethral resections for nodular hyperplasia. (Jung et al, 2006)

Men who have findings suspicious for carcinoma on digital rectal examination and a tPSA of @<@4 ng/mL have a probability of cancer of at least 10%, while those with tPSA levels from 4 to 10 ng/mL have a 25% probability. Men with tPSA’s above 10 ng/mL have a >50% likelihood of having a prostate cancer. (Demura et al, 1996)


Prostatic adenocarcinomas are composed of small glands that are back-to-back, with little or no intervening stroma.

Cytologic features of adenocarcinoma include enlarged round, hyperchromatic nuclei that have a single prominent nucleolus.

Mitotic figures suggest carcinoma. Less differentiated carnomas have fucised glands called cribriform glands, as well as solid nests or sheets of tumor cells, and many tumors have two or more of these patterns.

Prostatic adenocarcinomas almost always arise in the posterior outer zone of the prostate and are often multifocal. (Pearson et al, 1996)

Prostatic adenocarcinomas are usually graded according to the Gleason grading system based on the pattern of growth.

There are 5 grades (from 1 to 5) based upon the architectural patterns.

Adenocarcinomas of the prostate are given two grade based on the most common and second most common architectural patterns.

These two grades are added to get a final grade of 2 to 10. The stage is determined by the size and location of the cancer, whether it has invaded the prostatic capsule or seminal vesicle, and whether it has metastasized.


- Variants of usual acinar adenocarcinoma of the prostate (2004 World Health Organization classification)

  • atrophic prostatic adenocarcinoma
  • pseudohyperplastic prostatic adenocarcinoma
  • foamy prostatic adenocarcinoma
  • colloid prostatic adenocarcinoma (mucinous prostatic adenocarcinoma)
  • signet ring prostatic adenocarcinoma
  • oncocytic prostatic adenocarcinoma
  • lymphoepithelioma-like prostatic adenocarcinoma

- Variants of non-acinar carcinoma of the prostate (2004 World Health Organization classification Sarcomatoid carcinoma)

  • prostatic ductal adenocarcinoma
  • prostatic squamous cell carcinoma and adenosquamous carcinoma
  • prostatic urothelial carcinoma
  • prostatic small-cell carcinoma
  • prostatic basal cell carcinoma
  • prostatic clear cell adenocarcinoma

- Variants of prostatic carcinoma described since the 2004 World Health Organization classification

  • prostatic microcystic adenocarcinoma
  • prostatic PIN-like adenocarcinoma
  • prostatic large-cell neuroendocrine carcinoma
  • prostatic pleomorphic giant cell adenocarcinoma
  • PIN (prostatic intraepithelial neoplasia)

American Urological Society Clinical Staging

Stage Definition 10-year Survival
A1 Incidental, @<@5% of volume 93-98%
A2 Incidental, >5% of volume, or high grade 50%
B1 Palpable nodule in one lobe but @<@1.5 cm in diameter 70-75%
B2 Larger palpable nodule 62%
C1 Invades capsule of prostate 40-50%
C2 Invades seminal vesicle 33-39%
D1 Metastases to regional lymph nodes, or extensive regional spread 17-20%
D2 Evident distant metastases @<@10%


The grade and the stage correlate well with each other and with the prognosis.

The prognosis of prostatic adenocarcinoma varies widely with tumor stage and grade.

Cancers with a Gleason score of @<@6 are generally low grade and not aggressive.

Advanced prostatic adenocarcinomas typically cause urinary obstruction, metastasize to regional (pelvic) lymph nodes and to the bones, causing blastic metastases in most cases.

Metastases to the lungs and liver are seen in a minority of cases. (Gleason, 1992) (Bostwick, 1996) (Epstein, 2010)


- prostatic adenocarcinomas

- prostate carcinoma with squamous differentiation (15105655)

According to androgen dependance

- androgen-dependent prostate cancer
- androgen-independent prostate cancer


- Positive IHC

  • PSA/Prostate specific antigen,
  • PAP/prostatic acid phosphatase,
  • NKX3.1,
  • PSMA
  • AMACR,
  • AR,
  • P501S/prostein
  • LMWK, CD57/Leu7, B72.3, EMA/Epithelial Membrane Antigen

- Negative IHC

  • p63
  • GATA3
  • Cytokeratin 34βE1, also called cytokeratin 903,
  • CEA, CK7, CK20, Thrombomodulin, MUC6, CD10, CA125, CK17, TTF1, Villin, WT1

Differential diagnosis

Features against the diagnosis of adenocarcinorna :
- atrophic cytoplasm
- merging in with benign glands (r/o adenosis )
- corpora amylacea
- inflammation
- adjacent PIN (r/o PINATYP )

Abnormal protein expression

- aberrant diffuse expression of p63 (18300803)

Molecular biology

- DNA microarrays: 12084220
- Proteomics: 11721637

By genes



- see "prostate cancer genetics"


- WebPathology

Open references

- PTEN loss is associated with upgrading of prostate cancer from biopsy to radical prostatectomy. Lotan TL, Carvalho FL, Peskoe SB, Hicks JL, Good J, Fedor HL, Humphreys E, Han M, Platz EA, Squire JA, De Marzo AM, Berman DM. Mod Pathol. 2015 Jan;28(1):128-37. doi : 10.1038/modpathol.2014.85 PMID: 24993522


- Targeted therapy in prostate cancer. Corcoran NM, Gleave ME. Histopathology. 2012 Jan;60(1):216-31. PMID: 22212088

- Prostate cancer and inflammation: the evidence. Sfanos KS, De Marzo AM. Histopathology. 2012 Jan;60(1):199-215. PMID: 22212087

- Anatomy of the prostate revisited: implications for prostate biopsy and zonal origins of prostate cancer. Fine SW, Reuter VE. Histopathology. 2012 Jan;60(1):142-52. PMID: 22212083

- Staging of prostate cancer. Cheng L, Montironi R, Bostwick DG, Lopez-Beltran A, Berney DM. Histopathology. 2012 Jan;60(1):87-117. PMID: 22212080

- Histological variants of prostatic carcinoma and their significance. Humphrey PA. Histopathology. 2012 Jan;60(1):59-74. PMID: 22212078

- Diagnosis of limited adenocarcinoma of the prostate. Epstein JI. Histopathology. 2012 Jan;60(1):28-40. PMID: 22212076

- The impact of the 2005 International Society of Urological Pathology (ISUP) consensus on Gleason grading in contemporary practice. Zareba P, Zhang J, Yilmaz A, Trpkov K. Histopathology. 2009 Oct;55(4):384-91. PMID: 19817888

- Pitfalls in the diagnosis of prostatic cancer: retrospective review of 1791 cases with clinical outcome. Berney DM, Fisher G, Kattan MW, Oliver RT, Møller H, Fearn P, Eastham J, Scardino P, Cuzick J, Reuter VE, Foster CS; Trans-Atlantic prostate group. Histopathology. 2007 Oct;51(4):452-7. PMID: 17880526

- Diagnostic utility of immunohistochemistry in morphologically difficult prostate cancer: review of current literature. Varma M, Jasani B. Histopathology. 2005 Jul;47(1):1-16. PMID: 15982318

- Pre-neoplastic lesions of the prostate. Parkinson MC. Histopathology. 1995 Oct;27(4):301-11. PMID: 8847060

References 2

- Humphrey PA. Variants of prostatic carcinoma. Prostate pathology. Chicago, IL: ASCP Press, 2003; 390–429.

- Humphrey PA. Unusual prostatic neoplasms. Prostate pathology. Chicago, IL: ASCP Press, 2003; 430–455.

- Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Tumours of the prostate. In Eble JN, Sauter G, Epstein JI, Sesterhenn IA eds. Tumours of the urinary system and male genital organs. Lyon: IARC Press, 2004; 159–214.

- Epstein JI, Cubilla AL, Humphrey PA. Tumors of the prostate gland, seminal vesicles, penis, and scrotum. AFIP Atlas of Tumor Pathology. Washington, DC: American Registry of Pathology, 2011; 239–267.

- Weiner EJC, Simpson JA, eds. The compact Oxford English dictionary, 2nd edn. Oxford: Oxford University Press, 2007; 2215.

- Yaskiv O, Cao D, Humphrey PA. Microcystic adenocarcinoma of the prostate: a variant of pseudohyperplastic and atrophic patterns. Am. J. Surg. Pathol. 2010; 34; 556–561.

- Hameed O, Humphrey PA. Stratified epithelium in prostatic carcinoma: a mimic of high-grade prostatic intraepithelial neoplasia. Mod. Pathol. 2006; 19; 899–906.

- Tavora F, Epstein JI. High-grade prostatic intraepithelial-like ductal adenocarcinoma of the prostate: a clinicopathologic study of 28 cases. Am. J. Surg. Pathol. 2008; 32; 1060–1067.

- Evans AJ, Humphrey PA, Belani J, van der Kwast TH, Srigley JR. Large cell carcinoma of prostate: a clinicopathologic summary of 7 cases of a rare manifestation of advanced prostate cancer. Am. J. Surg. Pathol. 2006; 30; 684–693.

- Lopez-Beltran A, Eble JN, Bostwick DG. Pleomorphic giant cell carcinoma of the prostate. Arch. Pathol. Lab. Med. 2005; 129; 683–685.

- Parwani AV, Herawi M, Epstein JI. Pleomorphic giant cell adenocarcinoma of the prostate: report of 6 cases. Am. J. Surg. Pathol. 2006; 30; 1254–1259.

- Bostwick DG, Meiers I. Diagnosis of prostatic carcinoma after therapy. Arch. Pathol. Lab. Med. 2007; 131; 360–371.

- Reuter VE. Pathological changes in benign and malignant prostatic tissue following androgen deprivation therapy. Urology 1997; 49(Suppl. 3A); 16–22.

- Egan AJ, Lopez-Beltran A, Bostwick DG. Prostatic adenocarcinoma with atrophic features: malignancy mimicking a benign process. Am. J. Surg. Pathol. 1997; 21; 931–935.

- Kaleem Z, Swanson PE, Vollmer RT, Humphrey PA. Prostatic adenocarcinoma with atrophic features: a study of 202 consecutive completely embedded radical prostatectomy specimens. Am. J. Clin. Pathol. 1998; 109; 695–703.

- Cina SJ, Epstein JI. Adenocarcinoma of the prostate with atrophic features. Am. J. Surg. Pathol. 1997; 21; 289–295.

- Farinola MA, Epstein JI. Utility of immunohistochemistry for alpha-methylacyl-CoA racemase in distinguishing atrophic prostate cancer from benign atrophy. Hum. Pathol. 2004; 35; 1272–1278.

- Hameed O, Humphrey PA. Immunohistochemistry in diagnostic surgical pathology of the prostate. Semin. Diagn. Pathol. 2005; 22; 88–104.

- Humphrey PA, Kaleem Z, Swanson PE, Vollmer RT. Pseudohyperplastic prostatic adenocarcinoma. Am. J. Surg. Pathol. 1998; 22; 1239–1246.
- Levi AW, Epstein JI. Pseudohyperplastic adenocarcinoma on biopsy and needle and simple prostatectomy. Am. J. Surg. Pathol. 2000; 24; 1039–1046.

- Arista-Nasr J, Martinez-Benitez B, Fernanadez-Amador JA et al. Pseudohyperplastic prostatic adenocarcinoma in simple prostatectomy. Ann. Diagn. Pathol. 2011; 15; 170–174.

- Zhou M, Jiang Z, Epstein JI. Expression and diagnostic utility of alpha-methylacyl-CoA-racemase (P504S) in foamy gland and pseudohyperplastic prostate cancer. Am. J. Surg. Pathol. 2003; 27; 772–778.

- Wolters T, van der Kwast TH, Vissers CJ et al. False-negative prostate needle biopsies: frequency, histopathologic features, and follow-up. Am. J. Surg. Pathol. 2010; 34; 34–43.

- Carswell BM, Woda BA, Wang X et al. Detection of prostate cancer by alpha-methylacyl CoA racemase (P504S) in needle biopsy specimens previously reported as negative for malignancy. Histopathology 2006; 48; 668–673.

- Nelson RS, Epstein JI. Prostatic carcinoma with abundant xanthomatous cytoplasm: foamy gland carcinoma. Am. J. Surg. Pathol. 1996; 20; 419–426.

- Zhao J, Epstein JI. High grade foamy gland prostatic adenocarcinoma on biopsy or transurethral resection. Am. J. Surg. Pathol. 2009; 33; 583–590.

- Tran TT, Sengupta E, Yang XJ. Prostatic foamy gland carcinoma with aggressive behavior: clinicopathologic, immunohistochemical, and ultrastructural analysis. Am. J. Surg. Pathol. 2001; 25; 618–623.

- Hudson J, Cao D, Vollmer R et al. Foamy gland adenocarcinoma of the prostate: incidence, Gleason grade, and early clinical outcome. Hum Pathol. 2011, in press.

- Berman DM, Yang X, Epstein JI. Foamy gland high-grade prostatic intraepithelial neoplasia. Am. J. Surg. Pathol. 2000; 24; 1401–1444.
- Dhom G. Unusual prostatic carcinomas. Pathol. Res. Pract. 1990; 186; 28–36.

- Epstein JI, Lieberman PH. Mucinous adenocarcinoma of the prostate gland. Am. J. Surg. Pathol. 1985; 9; 299–308.

- Ro JY, Grignon DJ, Ayala AG et al. Mucinous adenocarcinoma of the prostate: histochemical and immunohistochemical studies. Hum. Pathol. 1990; 21; 593–600.

- Lane BR, Magi-Galluzi C, Reuther AM et al. Mucinous adenocarcinoma of the prostate does not confer poor prognosis. Urology 2006; 68; 825–830.

- Osunkoya AO, Nielsen ME, Epstein JI. Prognosis of mucinous adenocarcinoma of the prostate treated by radical prostatectomy. A study of 47 cases. Am. J. Surg. Pathol. 2008; 32; 468–472.

- Lopez JI, Laforga JB. Mucinous (colloid) adenocarcinoma of the prostate. Br. J. Urol. 1995; 76; 805–806.

- Proia AD, McCaerty KS Jr, Woodard BH et al. Prostatic mucinous adenocarcinoma. A Cowper gland mimicker. Am. J. Surg. Pathol. 1981; 5; 701–706.

- Osunkoya AO, Epstein JI. Primary mucin-producing urothelial-type adenocarcinoma of prostate: report of 15 cases. Am. J. Surg. Pathol. 2007; 31; 1323–1329.

- Ro JY, El-Naggar A, Ayala AG et al. Signet ring cell carcinoma of the prostate. Electron-microscopic and immunohistochemical studies of eight cases. Am. J. Surg. Pathol. 1988; 12; 453–460.

- Guerin D, Hoasn N, Keen CE. Signet ring cell differentiation in adenocarcinoma of the prostate: a study of five cases. Histopathology 1993; 22; 367–371.

- Torbenson M, Dhir R, Nangia A et al. Prostatic carcinoma with signet ring cells: a clinicopathologic and immunohistochemical analysis of 12 cases, with review of the literature. Mod. Pathol. 1998; 11; 552–559.

- Warner JN, Nakamura LY, Pacelli A, Humphreys MR, Castle EP. Primary signet ring carcinoma of the prostate. Mayo Clin. Proc. 2010; 85; 1130–1136.

- Epstein JI, Allsbrook WC Jr, Amin MB et al. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. Am. J. Surg. Pathol. 2005; 29; 1228–1242.

- Fiandrino G, Lucioni M, Filippin F et al. Prostatic adenocarcinoma with oncocytic features. J. Clin. Pathol. 2011; 64; 177–178.

- Ordonez NG, Ro JY, Ayala AG. Metastatic prostatic carcinoma presenting as an oncocytic tumor. Am. J. Surg. Pathol. 1992; 16; 1007–1012.

- Pinto JA, Gonzalez JE, Granadillo MA. Primary carcinoma of the prostate with diffuse oncocytic changes. Histopathology 1994; 25; 286–288.

- Adlakha K, Bostwick DG. Lymphoepithelioma-like carcinoma of the prostate. J. Urol. Pathol. 1994; 2; 319–325.

- Lopez-Beltran A, Cheng L, Prieto R, Blanca A, Montironi R. Lymphoepithelioma-like carcinoma of the prostate. Hum. Pathol. 2009; 40; 982–987.

- Dundore PA, Cheville CJ, Nascimento AG, Farrow GM, Bostwick DG. Carcinosarcoma of the prostate. Report of 21 cases. Cancer 1995; 76; 1035–1042.

- Shannon RL, Ro JY, Grignon DJ et al. Sarcomatoid carcinoma of the prostate. A clinicopathologic study of 12 patients. Cancer 1992; 69; 2676–2682.

- Hansel DE, Epstein JI. Sarcomatoid carcinoma of the prostate: a study of 42 cases. Am. J. Surg. Pathol. 2006; 30; 1316–1321.

- Berney DM, Ravi R, Baithun SI. Prostatic carcinosarcoma with squamous cell differentiation: a consequence of hormonal therapy: report of two cases and review of the literature. J. Urol. Pathol. 1979; 11; 123–132.

- Poblet E, Gomez-Tierno A, Alfaro L. Prostatic carcinosarcoma: a case originating in a previous ductal adenocarcinoma of the prostate. Pathol. Res. Pract. 2000; 196; 569–572.

- Rogers CG, Parwani A, Tekes A, Schoenberg MP, Epstein JI. Carcinosarcoma of the prostate with urothelial and squamous components. J. Urol. 2005; 173; 439–440.

- Wick MR, Young RH, Malvesta R, Beebe DS, Hansen JJ, Dehner LP. Prostatic carcinosarcomas. Clinical, histologic, and immunohistochemical data on two cases, with a review of the literature. Am. J. Clin. Pathol. 1989; 92; 131–139.

- Ray ME, Wojno KJ, Goldstein KJ et al. Clonality of sarcomatous and carcinomatous elements in sarcomatoid carcinoma of the prostate. Urology 2006; 67; 423.

- Delahunt B, Eble JN, Nacey JN, Grebe SK. Sarcomatoid carcinoma of the prostate: progression from adenocarcinoma associated with p53 over-expression. Anticancer Res. 1999; 19; 4279–4283.

- Reuter VE. Sarcomatoid lesions of the urogenital tract. Semin. Diagn. Pathol. 1993; 10; 188–201.

- Bock BJ, Bostwick DG. Does prostatic ductal adenocarcinoma exist? Am. J. Surg. Pathol. 1999; 23; 781–785.

- Dube VE, Farrow GM, Greene LF. Prostatic adenocarcinoma of ductal origin. Cancer 1973; 32; 402–409.

- Bostwick DG, Kindrachuk RW, Rouse RV. Prostatic adenocarcinoma with endometrioid features. Clinical, pathologic, and ultrastructural findings. Am. J. Surg. Pathol. 1985; 9; 595–609.

- Brinker DA, Potter SR, Epstein JI. Ductal adenocarcinoma of the prostate diagnosed on needle biopsy. Correlation with clinical and radical prostatectomy findings and progression. Am. J. Surg. Pathol. 1999; 23; 1471–1479.

- Epstein JI, Woodruff JM. Adenocarcinoma of the prostate with endometrioid features. A light microscopic and immunnohistochemical study of ten cases. Cancer 1986; 57; 111–119.

- Lemberger RJ, Bishop MC, Bates CP, Blundell W, Ansell ID. Carcinoma of the prostate of ductal origin. Br. J. Urol. 1984; 56; 706–709.

- Ro JY, Ayala AG, Wishnow KI, Ordoñez NG. Prostatic duct adenocarcinoma with endometrioid features: immunohistochemical and electron microscopic study. Semin. Diagn. Pathol. 1988; 5; 301–311.

- Tannenbaum M. Histopathology of the prostate gland. In Tannenbaum M ed. Urologic pathology: the prostate. Philadelphia, PA: Lea and Febiger, 1977; 312–315.

- Copeland JN, Amin MB, Humphrey PA et al. The morphologic spectrum of metastatic prostatic adenocarcinoma to the lung: special emphasis on histologic features overlapping with other pulmonary neoplasms. Am. J. Clin. Pathol. 2002; 117; 552–557.

- Tu SM, Reyes A, Maa A et al. Prostate carcinoma with testicular or penile metastases. Clinical, pathologic, and immunohistochemical features. Cancer 2002; 94; 2610–2617.

- Carney JA, Kelalis PP. Endometrial carcinoma of the prostatic utricle. Am. J. Clin. Pathol. 1973; 60; 565–573.

- Zaloudek C, Williams JW, Kempson RL. ‘Endometrial’ adenocarcinoma of the prostate. A distinctive tumor of probably prostatic duct origin. Cancer 1976; 37; 2255–2262.

- Christensen WN, Steinberg G, Walsh PC, Epstein JI. Prostatic duct adenocarcinoma. Findings at radical prostatectomy. Cancer 1991; 67; 2118–2124.

- Walker AN, Mills SE, Feihner RE, Perry JM. Endometrial adenocarcinoma of the prostatic urethra arising in a villous polyp. Arch. Pathol. Lab. Med. 1982; 106; 624–627.

- Sogbein SK, Steele AA. Papillary prostatic epithelial hyperplasia of the urethra: a cause of hematuria in young men. J. Urol. 1989; 142; 1218–1220.

- Nishimura K, Higashino M, Hara T, Oka T. Prostatic adenocarcinoma showing features of endometrioid and mucinous carcinomas: a case report [in Japanese]. Acta Urol. Jpn. 1995; 41; 805–807.

- Kopelson G, Harisiadis L, Romas NA, Veenema RJ, Tannenbaum M. Periurethral prostatic duct carcinoma. Clinical features and treatment results. Cancer 1978; 42; 2894–2902.

- Pacchioni D, Casetta G, Piovano M et al. Prostatic duct carcinoma with combined prostatic duct adenocarcinoma and urothelial carcinoma features: report of a case. Int. J. Surg. Pathol. 2004; 12; 293–297.

- Millar EKA, Sharma NK, Lessels AM. Ductal (endometrioid) adenocarcinoma of the prostate: a clinicopathological study of 16 cases. Histopathology 1996; 29; 11–19.

- Ma TKF, Chapman WB, McLean M, Srigley J. Prostatic carcinosarcoma consisting of the unusual combination of ductal adenocarcinoma with osteogenic sarcoma: a report of a case and review of the literature. J. Urol. Pathol. 1998; 8; 111–120.

- Samaratunga H, Singh M. Distribution pattern of basal cells detected by cytokeratin 34 Beta E12 in primary prostatic duct adenocarcinoma. Am. J. Surg. Pathol. 1997; 21; 435–440.

- Colpaert C, Gentens P, Van Marck E. Ductal (‘endometrioid’) adenocarcinoma of the prostate. Acta Urol. Belg. 1998; 66; 29–32.
- Oxley JD, Abbott CD, Gillatt DA, MacIver AG. Ductal carcinomas of the prostate: a clinicopathological and immunohistochemical study. Br. J. Urol. 1998; 81; 109–115.

- Beach R, Gown AM, DePeralta-Venturina MN et al. P504S immunohistochemical detection in 405 prostatic specimens including 376 18-gauge needle biopsies. Am. J. Surg. Pathol. 2002; 26; 1588–1596.

- Kelemen K, Adley B, Yang XJ, Wang HL, Humphrey PA. Ductal adenocarcinoma of the prostate. A clinicopathologic study of 50 cases. Lab. Invest. 2006; 86; 144A.

- Dawkins HJ, Sellner LN, Turbett GR et al. Distinction between intraductal carcinoma of the prostate (IDC-P), high grade dysplasia (PIN), and invasive prostatic adenocarcinoma, using molecular markers of cancer progression. Prostate 2000; 44; 265–270.

- Han B, Mehra R, Suleman K et al. Characterization of ETS gene aberrations in select histologic variants of prostate carcinoma. Mod. Pathol. 2009; 22; 1176–1185.

- Morgan TM, Welty CJ, Vakar-Lopez F et al. Ductal adenocarcinoma of the prostate: increased mortality risk and decreased serum prostate specific antigen. J. Urol. 2010; 184; 2303–2307.

- Lee TK, Miller JS, Epstein JI. Rare histological patterns of prostatic ductal adenocarcinoma. Pathology 2010; 42; 319–324.

- Sanati S, Watson MA, Salavaggione AL, Humphrey PA. Gene expression profiles of ductal vs. acinar adenocarcinoma of the prostate. Mod. Pathol. 2009; 22; 1273–1279.

- Amin A, Epstein JI. Pathologic stage of prostatic ductal adenocarcinoma at radical prostatectomy: effect of percentage of the ductal component and associated grade of acinar adenocarcinoma. Am. J. Surg. Pathol. 2011; 35; 615–619.

- Samaratunga H, Duffy D, Yaxley J, Delahunt B. Any proportion of ductal adenocarcinoma in radical prostatectomy specimens predicts extraprostatic extension. Hum. Pathol. 2010; 41; 281–285.

- Lotan TL, Toubaji A, Albadine R et al. TMPRSS2–ERG gene fusions are infrequent in prostatic ductal adenocarcinomas. Mod. Pathol. 2009; 22; 359–365.

- Parwani AV, Kronz JD, Genega EM et al. Prostate carcinoma with squamous differentiation: an analysis of 33 cases. Am. J. Surg. Pathol. 2004; 28; 651–657.

- Little NA, Wiener JS, Walther PJ, Paulson DF, Anderson EE. Squamous cell carcinoma of the prostate: 2 cases of a rare malignancy and review of the literature. J. Urol. 1993; 149; 137–139.

- Mohan H, Bal A, Punia RPS et al. Squamous cell carcinoma of the prostate. Int. J. Urol. 2003; 10; 114–116.

- Bennett RS, Edgerton EO. Mixed prostatic carcinoma. J. Urol. 1973; 110; 561–563.

- Wernert N, Goebbels R, Bonkhoff H, Dhom G. Squamous cell carcinoma of the prostate. Histopathology 1990; 17; 339–344.

- Wang Q, Lin C-S, Unger PP. Squamous cell carcinoma arising in hormonally treated adenocarcinoma of the prostate. Int. J. Surg. Pathol. 1996; 14; 13–16.

- Miller VA, Reuter V, Scher HL. Primary squamous cell carcinoma of the prostate after radiation seed implantation for adenocarcinoma. Urology 1995; 46; 111–113.

- Al Adnani MS. Schistosomiasis, metaplasia and squamous cell carcinoma of the prostate: histogenesis of the squamous cancer cells determined by localization of specific markers. Neoplasma 1985; 32; 613–622.

- Arva NC, Das K. Diagnostic dilemmas of squamous differentiation in prostate carcinoma: case report and review of the literature. Diagn. Pathol. 2011; 6; 46–53.

- Cheville JC. Urothelial carcinoma of the prostate. An immunohistochemical comparison with high grade prostatic adenocarcicoma and review of the literature. J. Urol. Pathol. 1998; 9; 141–154.

- Greene LF, O’Dea MJ, Dockerty MG. Primary transitional cell carcinoma of the prostate. J. Urol. 1976; 116; 761–763.

- Goebbels R, Amberger L, Wernert N, Dhom G. Urothelial carcinoma of the prostate. Appl. Pathol. 1965; 3; 242–254.

- Nicolaisen GS, Williams RD. Primary transitional cell carcinoma of prostate. Urology 1984; 24; 544–549.

- heville JC, Dundore PA, Bostwick DG et al. Transitional cell carcinoma of the prostate. Clinicopathologic study of 50 cases. Cancer 1998; 82; 703–707.

- Oliai BR, Kahane H, Epstein JI. A clinicopathologic analysis of urothelial carcinomas diagnosed in prostate needle biopsy. Am. J. Surg. Pathol. 2001; 25; 794–801.

- Edge SE, Byrd DE, Compton CC et al. eds. AJCC cancer staging manual, 7th edn. New York: Springer, 2010.

- Losi L, Di Gregori C, Brausi M, Fante R, Hurlimann J. Expression of p53 protein in prostate cancers of different histologic types. Pathol. Res. Pract. 1994; 190; 384–388.

- Têtu B, Ro JY, Ayala AB et al. Small cell carcinoma of the prostate. Part 1. A clinicopathologic study of 20 cases. Cancer 1987; 59; 1803–1809.
- Amato RJ, Logothetis CJ, Hallinan R et al. Chemotherapy for small cell carcinoma of prostate origin. J. Urol. 1992; 147; 935–937.

- Hindson DA, Knight LL, Ocker JM. Small-cell carcinoma of prostate. Transient complete remission with chemotherapy. Urology 1985; 26; 182–184.

- Schwartz LH, Latrenta LR, Bonaccio E et al. Small cell and anaplastic prostate cancer—correlation between CT findings and prostate-specific antigen level. Radiology 1998; 208; 735–738.

- Oesterling JE, Hanzeur CG, Farrow GM. Small cell anaplastic carcinoma in clinical, pathological, and immunological study of 27 patients. J. Urol. 1992; 147; 804–807.

- Papandreou CN, Daliani DD, Thall PF et al. Results of a phase II study with doxorubicin, etoposide, and cisplatin in patients with fully characterized small cell carcinoma of the prostate. J Clin. Oncol. 2002; 20; 3072–3080.

- Abbas F, Civantos F, Benedetto P, Soloway MS. Small cell carcinoma of the bladder and prostate. Urology 1995; 46; 617–630.

- Christopher ME, Seftel AD, Sorenson K, Resnick MI. Small cell carcinoma of the genitourinary tract: an immunohistochemical, electron microscopic and clinicopathological study. J. Urol. 1991; 146; 382–388.

- Helpap B, Kollermann J. Undifferentiated carcinoma of the prostate with small cell features: immunohistochemical subtyping and reflections on histogenesis. Virchows Arch. 1999; 434; 385–391.

- Mackey JR, Au H-J, Hugh J, Venner P. Genitourinary small cell carcinoma: determination of clinical and therapeutic factors associated with survival. J. Urol. 1998; 159; 1624–1629.

- Ro JY, Têtu B, Ayala AG, Ordóñez NG. Small cell carcinoma of the prostate. II. Immunohistochemical and electron microscopic studies of 18 cases. Cancer 1987; 59; 977–982.

- Weaver MG, Abdul-Karim FW, Srigley JR. Paneth cell-like change and small cell carcinoma of the prostate. Two divergent forms of prostatic neuroendocrine differentiation. Am. J. Surg. Pathol. 1992; 16; 1013–1016.

- Nguyen-Ho P, Nguyen G-K, Villaneuva RR. Small cell anaplastic carcinoma of the prostate: report of a case with positive urine cytology. Diagn. Cytopathol. 1994; 10; 159–161.

- Shah RB, Mehra R, Chinnaiyan AR et al. Androgen-independent prostate cancer is a heterogeneous group of diseases: lessons from a rapid autopsy program. Cancer Res. 2004; 64; 9209–9216.

- Wang W, Epstein JI. Small cell carcinoma of the prostate: a morphological and immunohistochemical study of 95 cases. Am. J. Surg. Pathol. 2008; 32; 65–71.

- Yao JL, Madeb R, Bourne P et al. Small cell carcinoma of the prostate: an immunohistochemical study. Am. J. Surg. Pathol. 2006; 20; 705–712.

- Simon RA, di Sant’Agnese PA, Huang LS et al. CD44 expression is a feature of prostatic small cell carcinoma and distinguishes it from its mimickers. Hum. Pathol. 2009; 40; 252–258.

- Scheble VJ, Braun M, Wilbertz T et al. ERG rearrangements in small cell prostatic and lung cancer. Histopathology 2010; 56; 937–943.
- Guo CC, Dancer JY, Wang W et al. TMPRSS2–ERG gene fusion in small cell carcinoma of the prostate. Hum. Pathol. 2011; 42; 11–17.

- Williamson SR, Zhang S, Yao JL et al. ERG–TMPRSS2 rearrangement is shared by concurrent prostatic adenocarcinoma and prostatic small cell carcinoma and absent in small cell carcinoma of the urinary bladder: evidence supporting monoclonal origin. Mod. Pathol. 2011; 24; 1120–1127.

- Lotan TL, Gupta NS, Yao JL et al. ERG gene rearrangements are common in prostatic small cell carcinomas. Mod. Pathol. 2011; 24; 820–828.

- Stein ME, Bernstein Z, Abacioglu U et al. Small cell (neuroendocrine) carcinoma of the prostate: etiology, diagnosis, prognosis, and therapeutic implications—a retrospective study of 30 patients from the rare cancer network. Am. J. Med. Sci. 2008; 336; 478–488.

- Iczkowski KA, Ferguson KL, Grier DD et al. Adenoid cystic/basal cell carcinoma of the prostate. Am. J. Surg. Pathol. 2003; 27; 1523–1529.

- Mastropasqua MG, Pruneri G, Renne G, De Cobelli O, Viale G. Basaloid cell carcinoma of the prostate. Virchows Arch. 2003; 443; 787–791.
- Young RH, Frierson HF Jr, Mills SE et al. Adenoid cystic-like tumor of the prostate gland. Am. J. Clin. Pathol. 1998; 89; 49–56.

- Denholm SW, Webb JN, Howard GC, Chisholm GD. Basaloid carcinoma of the prostate gland: histogenesis and review of the literature. Histopathology 1992; 20; 151–155.

- Yang XJ, McEntee M, Epstein JI. Distinction of basaloid carcinoma of the prostate from benign basal cell lesions by using immunohistochemistry for bcl-2 and Ki-67. Hum. Pathol. 1998; 29; 1447–1450.

- Grignon DJ, Ro JY, Ordóñez NG, Ayala AG, Cleary KR. Basal cell hyperplasia, adenoid basal cell tumor, and adenoid cystic carcinoma of the prostate gland: an immunohistochemical study. Hum. Pathol. 1988; 19; 1425–1433.

- McKenney JK, Amin MB, Srigley JR et al. Basal cell proliferations other than usual basal cell hyperplasia: a clinicopathologic study of 23 cases, including four carcinomas, with a proposed classification. Am. J. Surg. Pathol. 2004; 28; 1289–1298.

- Montironi R, Mazzucchelli R, Stramazzotti D et al. Basal cell hyperplasia and basal cell carcinoma of the prostate: a comprehensive review and discussion of a case with c-erbB2 expression. J. Clin. Pathol. 2005; 58; 290–296.

- Ali TZ, Epstein JI. Basal cell carcinoma of the prostate: a clinicopathologic study of 29 cases. Am. J. Surg. Pathol. 2007; 31; 697–705.

- Singh H, Flores-Sandoval N, Abrams J. Renal-type clear cell carcinoma occurring in the prostate. Am. J. Surg. Pathol. 2003; 27; 407–410.

- Pan C-C, Chiang H, Chang Y-H et al. Tubulocystic clear cell adenocarcinoma arising within the prostate. Am. J. Surg. Pathol. 2000; 24; 1433–1436.

- Guaclo G, Ortega V, Ardao G, Cravioto F. Clear cell adeocarcinoma of the prostatic utricle in an adolescent. Ann. Diagn. Pathol. 2005; 9; 153–156.