Metastatic involvement resulting in voice alteration may occur from vocal cord infiltration or recurrent laryngeal nerve involvement. We present a case of metastatic prostate adenocarcinoma to the left infrahyoid neck compressing the larynx resulting in hoarseness. A case report with one-year follow-up is presented. The patient is a 65-year-old male with hoarseness and a left infrahyoid prostate metastases measuring 8 by 10 cm, effacing the left pyrifom sinus and shifting the true and false vocal cords to the right of midline, with cord morphology and mobility maintained. Definitive radiation therapy reduced the infrahyoid metastases with resolution of hoarseness. Phonatory alteration from metastatic prostate carcinoma is rare. We present a case of hoarseness resulting from displacement of the larynx from infrahyoid metastases, which resolved after reduction in size of the metastases with radiation therapy.