Ignorance is Bliss? A Case of Incidental Discovery of ATM Mutation in Prostate Cancer

A 67-year-old man with Gleason score 7 (3+4) prostate cancer, stage cT1cN0, favorable-intermediate risk was initially treated with bilateral nerve-sparing robotic-assisted laparoscopic prostatectomy with lymph node sampling. Final surgical pathology was notable for negative resection margins, no lymphovascular invasion, and negative lymph node involvement in 4 bilateral obturator lymph nodes sampled but the patient had seminal vesicle invasion. The patient was monitored with serial prostate-specific antigen (PSA) with PSA undetectable at 4 months after prostatectomy. PSA eventually climbed to 2.309 ng/mL and prostate-specific membrane antigen positron emission tomography (PSMA PET) was obtained, which demonstrated several minimally to mildly avid nodes in the left common iliac region with maximal standardized uptake values (SUVmax) of 3.9 (Fig. 1), and no evidence of local recurrence in the prostate bed.