Background: Prostate carcinoma is one of the most common malignancies in men worldwide. Needle biopsy remains the primary diagnostic modality, with histopathological evaluation providing essential information regarding tumor grade, pattern, and prognostic stratification. Objective: To systematically evaluate the spectrum of histopathological patterns of prostate carcinoma identified in needle biopsy specimens and their relative frequencies. Methods: A systematic search of PubMed, Scopus, and Web of Science was performed. Studies reporting histopathological patterns and Gleason grading in prostate needle biopsies were included. Data were pooled using a random-effects model. Results: A total of 16 studies (n ≈ 4,200 patients) were included. Acinar adenocarcinoma was the predominant histological type (>90%). Gleason score 6–7 tumors were most frequent, while high-grade tumors (Gleason ≥8) constituted 20–35% of cases. Variants such as ductal, mucinous, and signet-ring carcinomas were rare (<5%). Perineural invasion was observed in approximately 30–45% of cases. Conclusion: Acinar adenocarcinoma is the predominant histopathological pattern in prostate needle biopsies. Gleason grading remains the cornerstone for prognostication, with a significant proportion of patients presenting with intermediate to high-grade disease.