A 64-year-old patient with PSA relapse (T3aN0; Gleason score, 8; PSA level, 4.0 ng/mL; PSA doubling time, 5.9 months) radical prostatectomy, lymphadenectomy, and radiotherapy. 18F-choline-PET/CT showed no suspicious lesion (A–C); 68Ga-PSMA-PET/CT (D–F) showed multiple iliac and retroperitoneal lymph node metastases (arrows) without 18F-choline-uptake (arrows in panel A, B).