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Study Design: Case Report.Objective: The aim of this study was to emphasize the utility of routine biopsy during kyphoplasty and to report on a unique case of a patient with known history of prostate cancer found to have a new metastatic cancer.Summary Of Background Data: Vertebral Compression Fractures (VCFs) may cause debilitating pain with nearly 1/3 of them leading to chronic pain resulting in a tremendous impact on quality of life in patients. Kyphoplasty has been established as an effective means of surgical treatment. However, routine biopsy during kyphoplasty is currently not the standard of care under the presumption that most VCFs are caused by osteoporosis. The role of biopsy in the setting of known malignancy with multiple other risk factors for VCFs is not well understood.Methods: We report on a case of a 73 year old male with known prostate cancer presenting with persistent unremitting low back pain failing conservative management. Patient develops multiple VCFs in the course of 6 months and is treated with multiple kyphoplasties. Routine biopsy at each level is negative until the last kyphoplasty results positive for malignancy. Surprisingly, the pathology is positive for malignancy other than the patient's known prostate cancer.Results: Pathology results prompt oncology workup on the patient which reveals multiple metastases and a new diagnosis of adenocarcinoma of possible upper gastrointestinal (GI) origin. In addition, patient's known prostate cancer is also noted to be active. Patient is subsequently started on chemotherapy.Conclusions: We highlight the utility of routine biopsy during kyphoplasty especially in patients with known history of malignancy. We emphasize that presumptions about the etiology of a VCF are difficult to make with multiple risk factors and that routine biopsy prevents incorrect presumptions such as in this case.Level of Evidence: 5. [ABSTRACT FROM AUTHOR]