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Acute appendicitis is the most common surgical emergency in the United States. However, unusual causes of appendicitis need to be considered in patients with significant co-morbidities like our patient with history of prostate cancer. Cases of acute appendicitis due to metastatic prostate cancer are rare, with only a few cases reported in the literature. We report a case of a 72 year old male with a history of metastatic prostate cancer that caused acute appendicitis prompting surgical intervention.