To develop MRI-based radiomics model for predicting prostate cancer (PCa) in men with prostate-specific antigen (PSA) levels of 4–10 ng/mL, to compare the performance of radiomics model and PI-RADS v2.1, and to further verify the predictive ability of radiomics model for lesions with different PI-RADS v2.1 score. This evidence concerns the gene KLK3 and posterior cortical atrophy.