For a study, the researchers aimed to emphasize the utility of routine biopsy during kyphoplasty and to report on a unique case of a patient with a known history of prostate cancer found to have a new metastatic cancer. Routine biopsy at each level was negative until the last kyphoplasty was positive for malignancy. Surprisingly, the pathology is positive for malignancy other than the patient’s known prostate cancer. The researchers reported on a case of a 73-year-old male with available prostate cancer presenting with persistent ongoing low back pain failing conservative management. The patient developed multiple VCFs in 6 months and was treated with various kyphoplasties. Pathology resulted in prompt oncology workup on the patient, which revealed numerous metastases and new results of adenocarcinoma of possible upper gastrointestinal origin. In addition, the patient’s known prostate cancer was also noted to be active. The patient was subsequently started on chemotherapy. The research highlighted the utility of routine biopsy during kyphoplasty, especially in patients with a known history of malignancy. Research during the process emphasized that presumptions about the etiology of a VCF were challenging to make with multiple risk factors and that routine biopsy prevented incorrect assumptions, such as in this case.