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Its role in identifying metastatic or secondary tumors, such as high-grade prostatic adenocarcinoma, is less widely recognized. The report describes an 82-year-old man whose post-cystoscopy bladder washing cytology showed atypical glandular cells. Strong NKX3.1 positivity supported prostatic origin and prostate resection confirmed ISUP Grade Group 4 with intraductal and cribriform features, with NKX3.1-positive malignant cells also found in follow-up voided urine.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/bladder-washing-cytology-in-the-detection-of-high-grade-prostatic-adenocarcinoma-a-case-report/423005/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/bladder-washing-cytology-in-the-detection-of-high-grade-prostatic-adenocarcinoma-a-case-report/423005.png","ImageObject",300,407,{"name":92,"@type":93},"dawugda","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-09-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is bladder washing cytology relevant for detecting high-grade prostatic adenocarcinoma?","Question",{"text":113,"@type":114},"The case report highlights bladder washing cytology as a potential diagnostic route when atypical glandular cells suggest a non-urothelial origin. Immunocytochemical confirmation helped establish prostatic disease in this scenario.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"How did NKX3.1 immunocytochemistry contribute to diagnosing the tumor origin?",{"text":118,"@type":114},"Strong NKX3.1 nuclear positivity on cytology supported a prostatic primary. The same marker was also identified on a follow-up voided urine sample.",{"name":120,"@type":111,"acceptedAnswer":121},"What diagnostic steps confirmed the suspected prostate cancer in the report?",{"text":122,"@type":114},"After cytology and PSA measurement, subsequent transurethral resection of the prostate confirmed high-grade prostatic adenocarcinoma. Histology established intraductal carcinoma and a cribriform growth pattern, classified as ISUP Grade Group 4.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},423005,1790815965,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},3985747870947,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Review began 11/11/2025  \nReview ended 12/01/2025  \nPublished 12/04/2025  \n© Copyright 2025  \nPastrana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98444  \nOpen Access Case Report  \nBladder Washing Cytology in the Detection of High-Grade Prostatic Adenocarcinoma: A Case Report  \nGabriel Pastrana 1 , Camille L. Santiago Negron 2, Suheidy Cardona 3 , Juan C. Santa Rosario 3, María D. Rivera Rolón 3  \n1. Pathology and Laboratory Medicine, University of Medicine and Health Sciences, Basseterre, KNA 2. Pathology and Laboratory Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, USA 3. Pathology and Laboratory Medicine, CorePlus, Carolina, USA  \nCorresponding author: Gabriel Pastrana, [gpastrana@umhs-sk.net](gpastrana@umhs-sk.net)  \nAbstract  \nBladder washing cytology is a valuable diagnostic tool primarily used in the evaluation of urothelial malignancies. However, its role in detecting metastatic or secondary malignancies, such as high-grade prostatic adenocarcinoma, is less commonly recognized. We present the case of an 82-year-old man whose post-cystoscopy bladder washing cytology revealed atypical glandular cells. Immunocytochemical staining showed strong NKX3.1 nuclear positivity, suggesting a prostatic origin. Subsequent transurethral resection of the prostate confirmed high-grade prostatic adenocarcinoma with intraductal carcinoma and a cribriform growth pattern, classified as International Society of Urological Pathology (ISUP) Grade Group 4 (Gleason score 4+4=8) . Notably, NKX3.1-positive malignant cells were also identified in a follow-up voided urine sample. This case underscores the potential utility of urine cytology, particularly when supplemented by immunocytochemistry, in the diagnosis of prostate cancer.  \nCategories: Urology, Pathology  \nKeywords: bladder washing cytology, high-grade prostate cancer, nkx3. 1 immunocytochemistry, prostatic  \nadenocarcinoma, urine cytology  \nIntroduction  \nProstate cancer is the most common non-skin malignancy diagnosed in men in the United States and is a leading cause of cancer-related morbidity and mortality worldwide [1] . Early detection relies primarily on prostate-specific antigen (PSA) testing, with histopathologic confirmation obtained through transrectal or transperineal prostate biopsy [1] . While these approaches are effective in most cases, atypical presentationsand diagnostic pitfalls can delay recognition, particularly in patients with coexisting urinary  \nsymptomatology or other genitourinary pathologies.  \nUrine cytology is a well-established, non-invasive diagnostic tool primarily intended for detecting highgrade urothelial carcinoma, especially in patients with hematuria or a history of urothelial neoplasia [2] . The Paris System for Reporting Urinary Cytology (TPS) standardizes interpretation by focusing on the  \nidentification of high-grade urothelial carcinoma and its precursors [2] . However, urine cytology may occasionally reveal malignant cells of non-urothelial origin, including secondary involvement by prostatic adenocarcinoma or other malignancies [3] . Such findings are uncommon and may be overlooked, particularly when clinical suspicion for prostate cancer is low or when urinary cytology is performed for unrelated indications. Supporting this, Tang et al. found that only 19.5% of urine cytology specimens from patients with histology-proven prostate cancer showed atypia or higher (C3+), and just 3.4% were suspicious or higher (C4+) [4] . The study also demonstrated that urine cytology is less sensitive in patients with low PSA, with a negative correlation between PSA ≤4 .0 ng/mL and positive cytology findings [4] . In comparison, higher PSA levels (>20 ng/mL) were positively correlated with detection [4] ","cbCaigXRpNkcgZfJ","https://ap.wps.com/l/cbCaigXRpNkcgZfJ","pdf",3117729,"English","# Abstract\n# Introduction\n# Case Presentation\n## Initial evaluation\n## Cytopathologic findings","[{\"question\":\"Why is bladder washing cytology relevant for detecting high-grade prostatic adenocarcinoma?\",\"answer\":\"The case report highlights bladder washing cytology as a potential diagnostic route when atypical glandular cells suggest a non-urothelial origin. Immunocytochemical confirmation helped establish prostatic disease in this scenario.\"},{\"question\":\"How did NKX3.1 immunocytochemistry contribute to diagnosing the tumor origin?\",\"answer\":\"Strong NKX3.1 nuclear positivity on cytology supported a prostatic primary. The same marker was also identified on a follow-up voided urine sample.\"},{\"question\":\"What diagnostic steps confirmed the suspected prostate cancer in the report?\",\"answer\":\"After cytology and PSA measurement, subsequent transurethral resection of the prostate confirmed high-grade prostatic adenocarcinoma. Histology established intraductal carcinoma and a cribriform growth pattern, classified as ISUP Grade Group 4.\"}]","Bladder Washing Cytology in the Detection of High-Grade Prostatic Adenocarcinoma - A Case Report | PDF",1790629705,13]