Introduction: Bone metastases from prostate cancer are commonly osteoblastic and can result in disabling skeletal complications and affect quality of life. We report a rare case of prostate cancer presenting with diffuse osteolytic metastases. Case Report: A 65-yearold African American man, with no past medical history or specific urologic symptoms, sought medical attention for non-specific pain symptoms. He had metastatic prostate adenocarcinoma, high PSA level (7242 ng/mL) and extensive osteolytic metastases. After one year of therapy with antiandrogens, zoledronic acid and local radiation, patient was asymptomatic and did not suffer disabling skeletal complications. His PSA level has been stable and less than 1 ng/mL. Conclusion: Prostate cancer can rarely present with diffuse osteolytic metastases. Early initiation of supportive treatment, especially the bisphosphonate zoledronic acid, plays a pivotal role in the reduction of disabling skeletal complications.