A 75-year-old man with newly diagnosed high-risk prostate cancer (cT3bN0M0) underwent <sup>18</sup>F-PSMA PET/CT, which demonstrated intense tracer uptake in a left tracheal mass causing near-complete luminal obstruction, raising suspicion of a primary lung malignancy or metastatic disease. This evidence concerns the gene FOLH1 and Familial prostate cancer.