Hiroshima opened the score in the top of the second inning on a single by Tsubasa Aizawa.
In the fourth, Fukuoka took a 2-1 lead, thanks to a 2-run single by Akira Nakamura.
Hereafter, the team got the bases loaded, but failed to take more distance and left three runners behind.
In the top of the fifth inning, Cuban reliever Liván Moinelo Pita took over the pitching for Fukuoka, but he gave up a 2-run homerun to Yoshihiro Maru.
In the bottom of the fifth, Fukuoka came alongside, but again failed to add more runs.
Takuya Kai and Seiji Uebayashi began with singles and advanced on a sacrifice bunt.
Hereafter, American Johnny Hellweg became the new pitcher for Hiroshima.
The righthander briefly pitched in the Major League for Milwaukee Brewers during the 2013 season and then was 1-4.
Thereafter, Hellweg missed most of the 2014 season with an injury, but he returned to the mound the following year, pitching in Single-A and Double-A.
In 2016 and 2017, he pitched in the Minor League for the San Diego Padres and Cincinnati Reds, but also played in an Independent League.
This year, he played in the organization of the Pittsburgh Pirates, but was released in June and then was signed by Hiroshima.
With the runners on second and third base, Hellweg hit Cuban Yurisbel Gracial Garcia with a pitch, which loaded the bases.
The tying run was then scored on a comeback-grounder by Yuki Yanagita to Hellweg, who opted to throw to first base instead of to the plate.
But thereafter, two runners were left behind.
In the top of the sixth, Hiroshima took a 4-3 lead when Tsubasa Aizawa homered.
The score was tied again in the seventh when Kenji Akashi hit a homerun for Fukuoka.
As the score was still tied after nine innings, the game went into extra innings.
Fukuoka then won the game in the tenth when Yuki Yanagita hit a lead-off walk-off homerun to end the 4 hours and 25 minutes game.
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Fukuoka wins third consecutive game in Japan Series
CHŪŌ-KU, FUKUOKA (Japan) -
Defending champion Fukuoka SoftBank Hawks won 5-4 in ten innings on Thursday (November 1) against Hiroshima Toyo Carp in Game 5 of the 69th Nippon Series.
With the win, Fukuoka now leads 3-1 and is one win away to win its second straight title.
The Series now returns to Hiroshima, where Game 6 will be played on Saturday.
In that game, Dutch pitcher Rick van den Hurk could be the starter for Fukuoka, but that has not yet been confirmed.
When Fukuoka then also wins, it will be the champion for the fifth time since 2011.
Hiroshima won its last title in 1984.