Age, PSA, PSAd, and prostate volume significantly differed between the non-PCa and PCa groups, with AUC values of 0.629, 0.709, 0.809, and 0.703, respectively, and were significantly associated with malignant pathology (<i>P</i>< 0.001, univariate logistic regression analysis).<h4>Conclusion</h4>Combining the PI-RADS with other clinical indicators effectively enhanced its initially low PPV for transitional zone lesions, particularly when the PSAd was ≥0.15 ng/mL<sup>2</sup> or the PSA was >10 ng/mL. The gene discussed is KLK3; the disease is posterior cortical atrophy.