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Prostate cancer afflicts a substantial portion of the male population with increasing incidence each decade after the age of 40. Standard of care for localized disease at presentation includes prostatectomy and/or radiation therapy which can include management of pelvic lymph nodes. However, the selection of lymph nodes treated by radiotherapy remains variable among practitioners including individual practitioners in the same institution. We present a patient with prostate adenocarcinoma who underwent radical prostatectomy with adjuvant radiotherapy for lymph node involvement and developed mesorectal failure secondary to metastatic spread to untreated tissue.