Ductal ("endometrioid") adenocarcinoma of the prostate is a rare variant of prostatic carcinoma which may have a different clinical presentation than the more common acinar adenocarcinoma. Ductal adenocarcinoma usually involves the urethra and the large periurethral prostatic ducts with direct spread through the more peripheral ductal system. Centrally located tumours have a much better prognosis than tumours involving the deep prostatic parenchyma. Local recurrence rate is high and five-year survival rate is as low as 24% for adenocarcinomas that have spread to the peripheral prostatic ducts. Although there have been some doubts about the role of hormonal therapy in ductal ("endometrioid") adenocarcinoma of the prostate, it is now agreed that therapeutic regimens should not be different from those offered to patients with conventional acinar adenocarcinoma.