68Ga-PSMA PET/CT is widely used for the evaluation of prostate cancer recurrence and metastasis. We present a case of increased PSMA uptake in segment 3 of the liver, corresponding to a region spared from diffuse hepatic steatosis. This uptake pattern may mimic focal hepatic metastasis. Recognition of steatosis sparing on CT or MRI is essential to avoid misinterpretation. This case highlights the importance of correlating functional and anatomic imaging to correctly identify physiological and benign variants in 68Ga-PSMA PET/CT interpretation.