The results of univariate and multivariable analyses demonstrated that the PI-RADS score (P < 0.001, OR: 5.724, 95% CI: 4.517–7.253)/(P < 0.001, OR: 5.199, 95% CI: 4.039–6.488) and prostate-specific antigen density (PSAD) (P < 0.001, OR: 2.756, 95% CI: 1.560–4.870)/(P < 0.001, OR: 4.726, 95% CI: 2.661–8.396) were the independent clinical factors for predicting total PCa/csPCa. Here, KLK3 is linked to posterior cortical atrophy.