A 61-year-old patient with hormone refractory PCA (initial pT3c pN0 M0) and treated with radical prostatectomy followed by radiation therapy was referred with PSA relapse (PSA serum level: 43 ng/dl). (a) 18F-FECH-PET/CT of the brain, axial fused planes (upper image), axial CT plane (middle image), and PET (lower image) showed a delineated increased uptake within the brain parenchyma located in the left temporal lobe matching to a well-circumscribed hyperdense area in CT in terms of a brain metastasis. This was histologically confirmed. Note the high tumor-to-background signal. (b) 18F-FECH-PET (MIP) shows numerous supratentorial and infratentorial brain metastases in addition to the lung metastases (posterior view).