Diagnosis: Invasive urothelial carcinoma + high-grade prostate adenocarcinoma.     

            Comment: Urothelial carcinoma of the prostate usually represents spread from carcinoma in the bladder and urethra as in this particular case. Up to 41% of patients may present unsuspected coexistent prostatic adenocarcinoma (Revelo MP et al. Incidence and location of prostate and urothelial carcinoma in prostates from cystoprostatectomies: implications for possible apical sparing surgery. J Urol 2008;179 (Suppl 5):S27-32). The urothelial carcinoma (Fig.1) shows glandular differentiation (Fig.2) and is PSA negative (Fig.3). Note the nuclear pleomorphism of the urothelial carcinoma in contrast to the more uniform nuclei in the PSA positive (Fig.5) prostate adenocarcinoma (Fig.4) which show conspicuous nucleoli.