In multivariable analysis, EpCAM/Cr (aOR = 1.07; 95% CI: 1.02-1.14; p = 0.009) and PSA density (aOR = 1.81; 95% CI: 1.20-3.18; p = 0.013) were independent predictors of csPCa, and EpCAM/Cr correlated positively with tumour aggressiveness (ρ = 0.609; p < 0.001).<h4>Conclusion</h4>Urinary EpCAM/Cr shows promise as a noninvasive biomarker for detecting csPCa in men with PSA levels in the diagnostic grey zone. The gene discussed is EPCAM; the disease is neoplasm.