Prostate carcinoma is a very rare origin of metastatic disease in the ureter. We report a case of a 74-year-old man who presented in November 2008 initially with flank pain and lower urinary tract symptoms. Diagnostic investigation revealed a skeletal metastasizing prostate carcinoma, and the cause for the flank pain was a hydronephrosis due to ureteral metastasis diagnosed by biopsy. Antihormonal treatment led to disappearance of the hydronephrosis; however, further progress finally ended in acute liver failure with patient's death in July 2010.