Decreased PSA screening rates—witnessed with the COVID-19 pandemic in 2020 and the USPSTF downgrading of PSA screening to grade D in 2012—are associated with increased metastatic prostate cancer incidence.4,5 Men younger than 65 years benefit most from prostate cancer screening but are also more likely to have HDHPs.6 Thus, the association of HDHPs with screening may be amplified. This evidence concerns the gene KLK3 and metastatic prostate carcinoma.