Zhang F, et al. - A 64-year-old man was hospitalized for raised prostate-specific antigen following radical prostatectomy. Hydronephrosis caused by a mass in the left renal pelvis without important uptake of prostate-specific membrane antigen (PSMA) tracer was exhibited by ⁶⁸Ga-PSMA-11 PET/CT. The histopathology designated metastatic PCa with a Gleason score of 5+5 however it was negative for PSMA after nephroureterectomy. Nevertheless, when with hydronephrosis is observed in individuals with prostate cancer, metastasis to the renal pelvis is rare, the occurrence likelihood could not be disregarded.