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. Here, PROS1 is linked to posterior cortical atrophy.