PSA and prostate health: seven conversations · Part 4 of 7

My repeat PSA is still high. What would I check next?

By Dr. Josh · Oct 21, 2026

If my repeat PSA were still high, would biopsy automatically come next? I would book a urology visit and work through the reason for a biopsy before assuming the answer.

I would bring earlier reports and review my overall risk and prostate size. PSA density is PSA divided by prostate volume, adding useful context. The speed of a rise alone should not decide on biopsy.

Next I would ask whether an MRI before biopsy could help us decide or locate an area to sample. Would a test such as PHI or 4Kscore change that decision? If it would not, I would ask what I would gain by adding it.

If the imaging looked reassuring, I would agree on when to reassess and what changes should bring me back sooner. MRI and biomarkers cannot guarantee there is no cancer; higher overall risk may still call for biopsy. I would want fewer unhelpful tests without skipping something I need.