(A–D) Male 66 years, cTxN1M1, initially non-resectable, PCa, GlS = 7 (4 + 3). PSA 35.2 ng/mL. After palliative radiotherapy on the left hip and pubic bones, during hormonal therapy, previous history of hematuria. Currently, on the basis of TURCUT biopsy a bladder tumor can be seen on the left wall, also distal urethra involvement. Histology PCa GlS = 9 (4 + 5). Whole body WB-SPECT/CT (MIP) (A) and additional image fusion SPECT/CT (B–D) with [99mTc]Tc-PSMA-T4. High pathological uptake of radiotracer seen in right pubic bone (arrow B), left bladder wall involvement (arrow C) and distal urethra involvement (arrow D).