The introduction of the prostate specific membrane antigen (PSMA) offers the possibility to discover prostate cancer recurrences being frequently so small that they cannot be detected by conventional imaging modalities, such as magnetic resonance or computed tomography.A 78 years old patient after radical prostatectomy and lymphadenectomy suffered from recurrence of the disease and galium-68-PSMA (Ga-PSMA) showed a single hot spot. Therefore, the first time in this indication in Austria radioguided surgery was performed after application of technetium-99m (Tc)-PSMA, which confirmed the single lesion already shown by Ga-PSMA.The lymph node was located dorsal to the urinary bladder dome in the presacral area, where normally no lymphadenectomy is performed, he was identified by the probe and removed. Postoperatively PSA-monitoring showed a decline from 13,1ng/mL (preoperatively) to <0,1ng/mL within 1 month.The use of radiolabeled PSMA (primary diagnosis with Ga, radioguided surgery with Tc and finally treatment with Lu) seems to be a major breakthrough in diagnosis and treatment of prostate cancer.