Prostatic paraganglia (PP) can simulate adenocarcinoma's fused gland pattern, and a differential diagnostic panel is developed. Their differential diagnosis with benign prostatic lesions has been largely unreported. Intraprostatic adipose tissue (IPAT) is seen extremely rarely in prostatic specimens, but it must be known, to avoid false positive results for extraprostatic fat carcinomatous invasion in needle biopsy specimens. We present one case from 100 randomly selected radical prostatectomy specimens in which our diagnosis evolved from IPAT to PP-hyperplasia, after additional immunohistochemical investigations. The presence of PP-hyperplasia, with both parenchymal and neurovascular bundle location, and its differential diagnosis with IPAT has not been previously reported.