A rectovesical fistula is an abnormal connection between the bladder and rectum. A rectovesical fistula is a theoretical, but rarely documented phenomenon following locally advanced prostate cancer treatment (radiation therapy, cryotherapy, etc.). Here, we present a case report of a mature rectovesical fistula thirteen years after the patient was treated with radiation therapy and salvage cryotherapy for locally advanced prostate cancer and the various treatment options.