Prostate cancer is rarely metastatic to visceral organs, and even less commonly to the brain. Recent data suggests brain metastasis from prostatic adenocarcinoma occur in 0.16% of patients, and almost universally in the setting of very high-volume disease. We present a man with an abruptly symptomatic brain lesion that developed at a PSA value of 1.5 ng/mL with no other known metastatic disease and required emergent neurosurgical resection. The patient had been initially treated with radiotherapy for Grade Group 4 prostate cancer in 2005 with a long period of PSA suppression.