Univariate analysis indicated that age (P = 0.035, hazard ratio [HR] 5.812), gland volume (P = 0.006, HR 3.816), PPB addition (P = 0.007, HR 3.016), clinical stage (P < 0.001, HR 4.557), Gleason score (P = 0.001, HR 3.356), baseline PSA (P = 0.027, HR 1.558), Memorial Sloan-Kettering Risk Classification Standard score (P < 0.001, HR 7.658), PSA nadir (P < 0.001, HR 9.473), time to PSA nadir (P = 0.012, HR 3.113), PSADT (P = 0.042, HR 2.665), and PSA level reduction (P < 0.001, HR 13.463) were significant predictors of OS in patients with localized, high-risk PCa. Here, KLK3 is linked to posterior cortical atrophy.