<p>Despite advances in imaging diagnostics, the histological confirmation of suspected carcinoma through prostate core needle biopsy remains essential for therapy planning. Diagnosis is based on established morphological criteria such as architectural disturbances, cellular atypia, and the loss of the basal cell layer. In addition to the most common acinar prostate carcinoma, various subtypes and rare histological patterns exist, which must be differentiated from benign mimickers. Immunohistochemical methods support diagnostic accuracy but should be carefully interpreted in the context of morphology. Tumor extent in core biopsy specimens should preferably be reported in millimeters. Diagnostic uncertainties can be coded as atypical small acinar proliferation (ASAP) or atypical intraductal proliferation (AIP) to facilitate appropriate clinical interpretation.</p>