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Prostate cancer (PCa) is a common urogenital malignancy in elderly males. The typical clinical presentation of advanced PCa includes symptoms of the lower urinary tract. The most common sites of metastasis are the bone and regional lymph nodes. However, PCa with cervical lymphadenopathy as the initial symptom is extremely rare, and one of its variants, foamy gland adenocarcinoma, is even rarer. We present a case of a patient with foamy gland adenocarcinoma of the prostate having enlarged lymph nodes in the neck as the initial symptom. An 81-year-old male was admitted to the hospital with a chief complaint of an enlarged left cervical lymph node without any urological history. Cervical ultrasound showed multiple lymphadenopathies in the left supraclavicular region. The patient underwent a lymph node biopsy, and the pathology results revealed metastatic foamy gland adenocarcinoma of the prostate. Distant lymph node metastasis in PCa is a rare form of metastasis. The initial presentation and tests led to the diagnosis of foamy gland adenocarcinoma of the prostate with cervical lymph node metastasis. Following the diagnosis, the patient received conservative management with androgen deprivation therapy (bicalutamide and goserelin) and zoledronic acid. Unfortunately, he passed away 9 months later due to a COVID-19 infection. We present this rare variant of PCa metastasis to attract the attention of clinicians and pathologists.