Of the GMS-C tumors, EcnCS3 presented with a higher predominance of ISUP group grading 5 PCa (81.8%) over EcnCS1 (60.0%), with EcnCS3 predicting a poorer outcome for BCR than EcnCS1, indicating a more aggressive presentation for EcnCS3-GMS-C tumors. Here, BCR is linked to posterior cortical atrophy.