The doctor and the individual should make the decision about a biopsy together, based on the DRE and PSA results and any additional useful data.
A single elevated PSA value should be taken in context. Often it is helpful to consider an elevated value in reference to prior values for the same patient. For instance, a PSA of 4.5 that has been stable for many years is less likely to indicate cancer than a value that has risen from 2 to 4 to 6 in a couple of years.
It is also helpful to take prostate size into consideration, which allows the physician to calculate a PSA density (PSA per unit of prostate). Many studies he shown that a higher PSA density is more likely to indicate cancer.
In modern practice, a multi-parametric prostate MRI is extremely helpful for stratifying patients for biopsy. This test not only allows identification of high suspicion areas within the prostate, but can be complexed with MRI / ultrasound fusion biopsy platforms to allow for targeted biopsy, which vastly increases the accuracy of prostate biopsy.
Joseph Brito, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.