Prostatic abscess (PA) is a rare clinical entity due to a variety of causative organisms including gram-negative bacilli, anaerobic and fungal agents. We report on a 55-year-old, HIV+ patient presenting with a 2-week history of urethral discharge and a large PA. He was successfully treated with a combination of radiological-guided transperineal drainage plus antibiotics. Treatment decisions in patients with PA are multifactorial and should be made with all diagnostic information available from the most current modes of medical imaging. In the case of PA several factors should be assessed, including size of the prostate, size, location and frequency of abscesses, previous pelvic surgery, relevant co-morbidities and risk factors, and patient preference.