This molecular tumor board is a rare example of having complete whole-genome sequencing data from the germline and tumor in a living patient facing aggressive prostate cancer in real-time. We provide a case report of how our multidisciplinary team of medical oncologists, pathologists, cancer biologists, and bioinformatics specialists thinks through the complexities of this big data and interprets it in the context of his care, and helps to explain the patient’s extraordinary response to radiation and hormonal therapy over many years.