When should a prostate biopsy be done if a man has a normal PSA? Thank you.

Edouard J. Trabulsi, MD

Academic Title: Associate Professor

Board Certifications:
Urology

This is a complicated question, without a single answer.

If the DRE is abnormal, with a nodule present, that would be a reason to do a prostate biopsy even with a normal PSA. Also, if the PSA rose quickly from one year to the next that would be a reason to do a prostate biopsy even if the PSA were normal.
A single PSA value alone is not as helpful to determine the risk of prostate cancer as is the rate of change of PSA over time. Additionally, the definition of 'normal' PSA has changed over the past several years, with the traditional upper limit value of 4 now lowered in younger men, to a value of 2.5 in men under the age of 50.