In a cohort of patients with high-risk hormone-sensitive prostate cancer without evidence of metastatic disease by conventional imaging, PSMA-PET results were positive in 84% of patients, detected M1 disease stage in 46% of patients, and found polymetastatic disease (≥5 lesions) in 24% of patients, suggesting that patients’ high-risk nonmetastatic hormone-sensitive prostate cancers are understaged by conventional imaging. This evidence concerns the gene FOLH1 and Familial prostate cancer.