While Dkk-3 levels as a single marker distinguished between prostate cancer and non-cancer on the basis of TRUS biopsies in the study cohort with a similar diagnostic accuracy compared with serum PSA (SP Dkk-3: AUC = 0.633; serum PSA: AUC = 0.644), the diagnostic accuracy of SP Dkk-3 levels was enhanced in multivariate models including serum PSA (model A) and both, serum and SP PSA levels (model B). Here, DKK3 is linked to cancer.