A 66-year-old male initially presented with intermittent macroscopic haematuria with an elevated prostate-specific antigen (PSA) of 9.8. He had a significant smoking history but was otherwise well. At cystoscopy, a papillary urethral lesion was found within the prostatic fossa and histology from this was suggestive of prostatic malignancy (Figure 1). Subsequent transrectal ultrasound biopsy confirmed Gleason 4+4=8 ductal prostatic adenocarcinoma. Staging demonstrated no metastases and the patient underwent radiation therapy with 18 months of adjuvant androgen deprivation therapy. His PSA reached a nadir of <0.01.