The authors confirmed that higher-Gleason PCa cases display increased kPL, LDHA, and MCT-4 expression/activity [40], suggesting that HP 13C MRI could be used to distinguish low-risk (Gleason score ≤ 3 + 4) from high-risk (Gleason score ≥ 4 + 3) PCa in the clinical setting, as discussed below. Here, LDHA is linked to posterior cortical atrophy.