The article presents a case study of an 85-year-old patient with developed Gleason 10 PCa and was treated with brachytherapy and undergone salvage prostatectomy. The patient was diagnosed with metastatic pelvic nodal disease and underwent microsatellite instability (MSI)-H tumor biopsy leading to the start of anti-PD1 therapy with pembrolizumab. The also undergone sets of prostate-specific membrane antigen (PSMA-PET) imaging.