The present study from India is a sobering reminder of prostate cancer presentation in absence of PSA screening: Of all 160 patients, 63% had PSA >100ng/mL, approximately 92% patients with PSA >20ng/mL, 50% patients had Gleason 9, 93% patients had Gleason 7 or higher with much higher frequency of metastatic disease and use of bilateral orchiectomy as ADT modality. The gene discussed is KLK3; the disease is metastatic neoplasm.