PCa diagnosis by the Free/Total (f/t) PSA ratio, which is lower in PCa compared to those with benign prostatic hyperplasia5–7 and other nomograms such as the 4Kscore8, are questioned for their clinical utility in discriminating indolent and aggressive PCa and the net benefit these tests add for clinical decision-making9. The gene discussed is KLK3; the disease is posterior cortical atrophy.