This case involves a forty-two-year-old male patient who was diagnosed with Stage III prostate cancer. The pathologist revealed on the initial pathology report a carcinoma of the prostate, with Gleason scores of 10 in several regions. A bone scan at the time revealed no evidence of metastatic disease and surgery was not recommended by his physician, but rather intraoperative, focused radiation and hormone deprivation therapy was initiated. The patient tolerated the treatment well with the exception of new onset urinary frequency and a constant feeling of incomplete emptying. At this time, the radiation oncologist ordered a full workup, including a bone scan and a CT of the abdomen and pelvis. The bone scan showed widespread metastatic disease to the spine, ribs, shoulders and pelvis.