Continuing prostate-specific antigen (PSA) screening after age 70 years might benefit men at high risk of prostate cancer–specific mortality (PCSM) or metastatic prostate cancer (mPCa), but the relative value of clinical factors (race and ethnicity, competing mortality, and PSA history) in identifying men at higher vs lower risk is unknown. Here, KLK3 is linked to prostate carcinoma.