Due to concern for metastatic disease, a PSMA scan was obtained which showed an intense PSMA avid lesion in the posterior aspect of the left prostate lobe concerning for site of primary prostatic malignancy (Figure 1(a)), a mildly PSMA avid subcentimeter left retroperitoneal and left iliac chain nodes concerning for nodal metastasis and a large continuous mixed lytic/sclerotic PSMA avid lesion within the left iliac bone extending from the iliac wing down to the anterior acetabulum (Figures 1(b), 1(c), and 1(d)). The gene discussed is FOLH1; the disease is metastatic neoplasm.