<b>Background:</b> In this study, it was aimed to compare transrectal ultrasound (TRUS)- and magnetic resonance imaging (MRI)-derived prostate-specific antigen density (PSAD) in patients with gray-zone PSA levels (4-10 ng/mL), evaluate their diagnostic performance for clinically significant prostate cancer (csPCa), and assess the clinical implications of reclassification across commonly used thresholds. Here, KLK3 is linked to Familial prostate cancer.