A 73 years old gentleman presented to private surgeon in January 2005 for acute urinary retention. Prostate specific antigen (PSA) level was elevated up to 50.18 ng/mL. Trans-rectal ultrasound guided biopsy showed no evidence of malignancy. Trans-ureteral resection of the prostate (TURP) was performed and pathology confirmed prostatic adenocarcinoma with combined Gleason grade 7 (3+4). Further workup with magnetic resonance imaging (MRI) showed features suggestive of carcinoma in the remaining prostate with involvement of the seminal vesicles. No local infiltration to the urinary bladder, pelvic muscle or enlarged pelvic or para-aortic lymph node was noted.