Clinical case from routine practice at the Peter MacCallum Cancer Centre (PMCC), where the use of PSMA PET/CT had dramatically changed therapeutic interventions. The patient presented with a PSA of 45 and a left Prostate Imaging Reporting and Data System (PIRADS) 5 lesion on MRI, with the biopsy confirming left GGG2 disease. The MRI and CT scans also showed a suspicious sclerotic lesion in the left iliac crest, which was concerning for bony metastases (A,B). The red arrow highlights the bony lesion in the left iliac crest. The bone appeared to show no apparent disease. Conversely, the PSMA PET/CT showed high PSMA avidity, with a maximum SUV (SUVMax) of 21.9 in the left prostate lesion and no avidity within the previously identified bone lesion (C,D). The patient proceeded to have a radical prostatectomy (RP) for localised high-risk PCa (E). At 3 years after the curative treatment, the patient’s PSA remained undetectable.