Despite 1 year of treatment with enzalutamide, he experienced disease progression (Figure 1B) with local recurrence and extensive lymph node metastases as well as appearance of a single bone lesion [red arrow in 18F-PSMA PET; since the lesion could be demarcated in subsequent 68Ga-PSMA scans and showed a correlate in CT, an unspecific bone uptake was unlikely (25)]; serum PSA increased to 63 ng/ml in May 2019. The gene discussed is FOLH1; the disease is metastatic malignant neoplasm in the lymph nodes.