A systemic workup was obtained, including magnetic resonance imaging of the brain and orbit, computed tomography of the chest, abdomen, and pelvis, and a bone scan. Computed tomography demonstrated multiple pulmonary nodules and prominent lymph nodes. The bone scan showed left iliac and right clavicle hot spots. Biopsy of the lung lesion confirmed metastatic prostate adenocarcinoma. His ocular lesion was presumed to be metastatic from the same primary cancer. He was treated with oral ketoconazole, 200 mg 3 times a day for 7 weeks, and 1 dose of intramuscular leuprolide acetate, 22.5 mg. At 7 weeks, visual acuity remained hand motions but the patient had a subjective improvement in vision. Ocular echography demonstrated a slight decrease in the apical dimension of the tumor. Ketoconazole was then discontinued while leuprolide acetate was maintained at a 30-mg intramuscular injection every 4 months. Five months after the initial visit, his visual acuity improved to 20/60 and retinal pigment epithelial changes appeared on the surface of the tumor. The tumor size decreased to 14.5 × 10 mm in basal dimension and a maximum apical height of 4 mm. Ten months later, the patient's visual acuity declined to counting fingers due to macular hemorrhages and choroidal atrophy. The tumor continued to decrease in size over several years. At the 5-year follow-up, the tumor has indistinct basal dimensions and a maximum apical height of 1.6 mm on echography.