We report a case of a 72-year-old male that underwent two sets of trans rectal prostatic needle biopsy (TPNB) within 9 month period. Pathology showed unremarkable benign prostatic tissues in the first group of biopsies while extensive diffuse inflammation with the characteristic features of malakoplakia in the second set. Three cores in the repeat biopsy contained foci of prosta tic adenocarcinoma as well. Occurrence of malakoplakia several months after TPNB in our case suggests that microorganisms may have been inoculated to the prostate during the biopsy procedure. We believe that malakoplakia must be added to the list of complications after TPNB.