KLK3 and metastatic prostate carcinoma: Several studies have demonstrated that, in the years after the Grade D recommendation, there have been decreases in PSA testing, prostate biopsies, and prostate cancer diagnoses.5,6 These decreases have been accompanied by a shift to higher-stage disease, including more metastatic prostate cancers at diagnosis and fewer low-grade prostate cancers.7,8,9,10