Despite the widespread adoption of prostate-specific antigen (PSA)-based screening, leading to a substantial increase in the diagnosis of low-risk PCa cases (cT1-2a, PSA < 10 ng/mL, ISUP grade 1), approximately 10% of patients continue to manifest locally advanced symptoms (such as bone pain, bilateral hydronephrosis, or acute urinary retention), posing a potentially life-threatening course [3]. Here, KLK3 is linked to posterior cortical atrophy.