Purpose: Neutral endopeptidase (CD10), an ectopeptidase bound to the cell surface, is thought to be a potential prognostic marker for prostate cancer. Experimental Design: Prostate cancer patients (N = 3,261) treated by radical prostatectomy at a single institution were evaluated by using tissue microarray. Follow-up data were available for 2,385 patients. The cellular domain (membranous, membranous-cytoplasmatic, and cytoplasmatic only) of CD10 expression was analyzed immunohistochemically and correlated with various clinical and histopathologic features of the tumors. Results: CD10 expression was detected in 62.2% of cancer samples and occurred preferentially in higher Gleason pattern (P < 0.0001). CD10 expression positively correlated with adverse tumor features such as elevated preoperative prostate-specific antigen (PSA), higher Gleason score, and advanced stage (P < 0.0001 each). Survival analyses showed that PSA recurrence was significantly associated with the staining pattern of CD10 expression. Outcome significantly declined from negative over membranous, membranous-cytoplasmatic, to exclusively cytoplasmatic CD10 expression (P < 0.0001). In multivariate analysis, CD10 expression was an independent predictor for PSA failure (P = 0.0343). Conclusions: CD10 expression is an unfavorable independent risk factor in prostate cancer. The subcellular location of CD10 protein is associated with specific clinical courses, suggesting an effect on different important biological properties of prostate cancer cells. The frequent expression of CD10 in prostate cancer and the strong association of CD10 with unfavorable tumor features may qualify this biomarker for targeted therapies.Neutral endopeptidase (CD10) may be a prognostic molecular marker in prostate cancer. This enzyme is a zinc-dependent, cell surface metallopeptidase that is widely expressed in the epithelial cells of the kidney, breast, lung, intestine, and prostate gland (1). It contains a large extracellular domain that inactivates various physiologically active peptides (e.g., bombesin, substance-P, endothelin-1) by cleavage (1). The exact physiologic significance of CD10 is unknown. CD10 plays a part in different cancers, including prostate cancer, where it has been shown to be involved in the migration, survival, and apoptosis of cancer cells, as well as tumor progression (2). Studies investigating the prognostic significance of the expression of CD10 in prostate cancer generated conflicting results. Zellweger et al. (3) and Freedland et al. (4) did not detect an association between CD10 expression and the recurrence of prostate-specific antigen (PSA) in prostate cancer. Osman et al. (5) reported a poor outcome for patients with CD10 loss; CD10 expression was an unfavorable risk factor in the series of Dall'Era et al. (6).We used an existing large-scale prostate cancer tissue microarray (7) constructed from 3,261 homogenously treated prostate cancers comprising 2,385 patients with follow-up information to further evaluate the potential progno...