Primary urothelial carcinomas of the prostate are exceedingly rare. More commonly, they represent secondary involvement of the prostate in conjunction with a bladder tumor. The image shows high-grade urothelial carcinoma in a prostate needle biopsy. The patient had elevated serum PSA and was thought to have high-grade high stage prostate cancer due to abnormal digital rectal exam. Urothelial carcinoma involving the prostate tends to form nests unlike high grade prostate cancer which grows in sheets, cords, or individual cells. Urothelial carcinoma also tends to be more pleomorphic than prostate cancer.