Prostatic Adenocarcinoma in Bladder

The patient had history of prostatic adenocarcinoma (Gleason score 4+3=7) treated with androgen deprivation therapy followed by radiation. He presented with a biochemical recurrence (elevated PSA) 3 years later and was found to have a bladder mass. The overlying urothelium is uninvolved. The tumor consists of anastomosing sheets and cords with a hint of gland formation. PSA and prostatic acid phoaphatase immunostains were strongly positive (see next image). High-grade urothelial carcinoma would have exhibited more pronounced nuclear pleomorphism and brisk mitotic activity.