Pure leiomyoma of the prostate is a rare lesion. We report a case in a 68-year-old man who presented with rectal symptoms. Rectal examination showed a stony hard nodule with irregular surface near the apex of the prostate. Transrectal sonography showed a homogeneous well defined nodule measuring 3.5 cm in diameter in the left prostatic lobe protruding into the bladder. Magnetic resonance imaging (MRI) revealed an irregular shaped mass in the prostate with an isosignal to muscle in the T1 weighted images. Needle biopsy revealed pure leiomyoma histologically. Transurethral resection was performed and a nodule of white almost avascular tissue was resected in the apex proximal to vermontanum. After operation, the rectal symptoms improved.