Neuroendocrine cells of the prostate are intraepithelial regulatory cells that secrete serotonin and a variety of peptide hormones. It is hypothesized that these cells regulate both growth and differentiation, as well as exocrine secretory activity through endocrine, paracrine, neurocrine, and lumenocrine mechanisms. Neuroendocrine differentiation in prostatic carcinoma occurs as pure neuroendocrine malignancies, such as small-cell carcinoma and carcinoid/carcinoid-like tumors, as well as focal neuroendocrine differentiation in a more conventional prostatic adenocarcinoma. Neuroendocrine differentiation in prostatic carcinoma may have diagnostic and prognostic significance.