High-risk PCa - as defined by a clinical stage ≥ T3, Gleason score of 8-10, or prostate-specific antigen (PSA) > 20 ng/ml at the time of diagnosis [2] - accounts for approximately one-quarter of all PCa diagnoses but was responsible for a disproportionately larger share of PCa-specific mortality (CSM) [3]. Here, KLK3 is linked to posterior cortical atrophy.