This 80-year-old patient presents with lower back pain after having been recently told that his prostate cancer was in remission. Observe the multiple radiopaque lesions scattered throughout the lumbar spine, pelvis and sacrum. There are very large round radiopaque lesions present within the L1, L2, L3 and L4 vertebral bodies. These radiopacities represent osteoblastic metastatic disease from this patient’s previously docomented prostate cancer. When prostate cancer spreads it usually seeds the lower abdominal and paraspinal lymph nodes as well as spreading to the bone. All of these radiopaque lesions in the pelvis and lumbar spine represent osteoblastic metastatic carcinoma from the patient’s prostate cancer. On some occasions the osteoblastic lesions can produce a classic “Ivroy vertebrae” with more uniform sclerosis. Paget’s disease often can produce an ivory vertebrae but will produce bone expansion to help differentiate this from osteoblastic metastasis which should not produce bone expansion. The most common location for osteoblastic metastasis from prostate cancer is to the proximal femurs, pelvis, sacrum and lumbar spine as noted in this case.