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Definitive treatment for local prostate cancer recurrence remains controversial. Early recurrences are often from positive surgical margins or nodal metastases, however other explanations should be considered. We present a case of a 79 year-old male with localized prostate cancer and early biochemical persistence after margin-negative robotic-assisted radical prostatectomy. Workup demonstrated a 0.9 cm rectal mass without nodal or distant metastasis, and biopsy revealed prostate adenocarcinoma. A subsequent transanal excision was performed. Post-operatively, his PSA dropped to 0.02 ng/mL. We present a rare case of prostate adenocarcinoma seeding after transrectal prostate biopsy and a review of the literature.