Introduction: Prostate cancer is the second most common cancer in men and the fifth most common cancer worldwide. Screening is based on Prostate Specific Antigen (PSA) blood test and digital rectal examination. The actual diagnosis of prostate cancer can only be made with a prostate biopsy. According to WHO reports, about 30% of the world's population has latent tuberculosis. Urogenital tuberculosis is responsible for one third of extrapulmonary cases. Bladder cancer is highly aggressive malignancy that causes significant morbidity and mortality. It is the most common malignancy of the urinary tract. Globally it is the 9th most common cancer diagnosed worldwide. Case description: A 70-year-old male was admitted to undergo fourth in his life transrectal prostate biopsy. He had a Prostate Specific Antigen level of over 1000ng/mL in a routine evaluation. Digital rectal examination revealed asymmetric enlargment of the prostate, with palpable nodules. Patient had medical history of non-muscle invasive bladder cancer, and received intravesical bacillus Calmette-Guerin immunotherapy. MRI of the spine revealed multiple metastases. All four biopsies were negative for prostate cancer. Nevertheless patient received hormonal treatment. Five months after last biopsy purulent fistula of both testes occurred and patient underwent bilateral orchiectomy. Histopathology revealed geni- tourinary tuberculosis and patient received treatment. Results and conclusions: Prostate cancer should always be con- sidered in elderly men with elevated PSA level and abnormal direct rectal examination findings. Both prostate cancer and tuberculosis may have unusual presentation. Despite negative Mantoux test, normal chest X-ray and negative MGIT BACTEC test patient suffered from genitourinary tuberculosis. Despite the fact that PSA serum level exceeded the norm by 250 times, the rectal examination was abnormal and metastases were well documented, the prostate cancer that was confirmed in the 5th biopsy. Take-home message: Urogenital tuberculosis is a forgotten clinical problem. Despite the progress in prevention, diagnosis and treatment of tuberculosis it still constitutes a major challenge in everyday clinical practice. Moreover tuberculosis is well known for its' ability to mas- querade as other infectious diseases and mimick cancer.