As previously presented for the Southern African Prostate Cancer Study (SAPCS)32,33 and in contrast to the National Cancer Consortium Network (NCCN) European-driven criteria that includes within the HRPCa definition as having a Prostate Specific Antigen (PSA) level >20 ng/mL, our African patients present with mean PSA levels 12.8-fold greater (255.94 ng/mL, range 4.28–4847 ng/mL). This evidence concerns the gene KLK3 and prostate cancer.