Despite the resection, the patient’s one-month postoperative PSA was found to have risen to 5.42 ng/mL; [68Ga]PSMA PET/CT was ordered, revealing interval development of mild PSMA avidity involving two pelvic lymph nodes, a left-sided mesorectal fascia nodule, and the S1 and S2 sacral nerve roots, raising concern for metastatic disease. The gene discussed is FOLH1; the disease is metastatic neoplasm.