Prostate gland & seminal vesicles

Other carcinomas

Urothelial carcinoma

Topic Completed: 1 July 2012

Minor changes: 30 October 2020

Copyright: 2003-2021,, Inc.

PubMed search: prostatic urothelial carcinoma

Komal Arora, M.D.
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Cite this page: Arora K. Urothelial carcinoma. website. Accessed November 27th, 2021.
Definition / general
  • Rare (< 2% of primary tumors) as primary in prostate (without bladder involvement); arises from urothelium in periurethral ducts that is histologically identical to bladder tumors

  • Immunostains:
Clinical features
  • Patient history is often bladder carcinoma in situ treated with intravesical chemotherapy (chemotherapy doesn’t reach prostatic urethra, prostatic ducts and acini), or patients with invasive bladder carcinoma and prostate gland involvement (occurs in 45% of cases, J Urol 2002;167:502, Actas Urol Esp 2012;36:545)
  • Usually invades bladder neck and surrounding soft tissue
  • 20% have distant metastases, commonly to bone, lung, liver
  • Bone metastases usually osteolytic, not osteoblastic
  • Poor prognosis even with in-situ disease only
  • Cystoprostatectomy, possibly chemotherapy, radiation therapy
  • Note: 50% with cystoprostatectomy for urothelial carcinoma also have prostate adenocarcinoma, although not necessarily high grade
Microscopic (histologic) description
  • In situ component usually present, consisting of nests of neoplastic cells filling prostatic ducts, often with central comedonecrosis
  • Stromal invasion almost always present and characterized by small nests of tumor cells with marked anaplasia and frequent mitotic figures, even compared to poorly differentiated prostatic adenocarcinoma
  • In prostate needle biopsies, often see in-situ only or in-situ plus invasion
  • Invasive urothelial carcinoma only is rare (9%)
  • Note: prostatic adenocarcinoma may have focal urothelial carcinoma features (Appl Immunohistochem Mol Morphol 2002;10:231)
  • Note: important to identify prostatic stromal invasion in cases with intraductal urothelial carcinoma, especially in patients with low grade bladder tumors, since prognosis is poor
Microscopic (histologic) images

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p63 / p501S differentiate prostatic and urothelial carcinoma

Differential diagnosis
  • Bladder extension of urethral carcinoma
  • High grade prostatic adenocarcinoma: less nuclear pleomorphism, prominent nucleoli, few mitoses, no / rare necrosis, no / rare pagetoid spread; see immunostains above (Am J Surg Pathol 2001;25:794)
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