The 2025 AUA/ASTRO/SUO guideline (last updated in 2022 and still current in 2025) [9] continues to use a three-tier risk system, designating localized PCa as high-risk when any one of the following is present: a clinical stage of cT3a, Grade Group 4 or 5 (Gleason 8–10), or a PSA level > 20 ng/mL. The gene discussed is KLK3; the disease is posterior cortical atrophy.