We found that hypoechoic lesions were significantly associated with the diagnosis of PCa in all the PSA intervals and had the highest predictive efficacy in patients with PSA > 100 ng/ml, as expected, followed by PSA 10–20, PSA 4–10, PSA < 4 and PSA 20–100 ng/ml groups. Here, KLK3 is linked to posterior cortical atrophy.