For the vast majority of men with urinary and sexual symptoms, the cause is benign, and in fact, men with an elevated PSA are less likely to be diagnosed with PCa if they also have LUTS or impaired sexual function.21 29 The pattern of PSA testing in the CPRD cohort suggests that many PSA tests are being undertaken to inform the diagnosis and management of LUTS and knowing which men had been PSA-tested because of a presentation with symptoms would have lent further support to this hypothesis. This evidence concerns the gene KLK3 and posterior cortical atrophy.