Should a person with a PSA level of 6.5 ng/mL and frequent urination undergo a biopsy?

Hello doctor,

As part of his routine annual medical checkup, my son-in-law, who has no family history of prostate cancer, mentioned his need for frequent urination. He is 5'11" feet tall, and of slim build. The doctor prescribed a number of tests, including PSA. Last month, the results showed all other parameters being normal except PSA of 6.5 ng/mL, and the case was referred to a urologist who did a digital exam two days ago. After the digital exam, the urologist said it is benign, but he would like to do a biopsy next week to be doubly sure. We are seeking a second opinion about the advisability of having a biopsy done at this stage because of the few doubts which are, there is no family history of prostate cancer, and he is only 44 years old. He has no other symptoms except having to urinate eight to nine times a day. There is only one report of PSA being elevated. Should a second PSA test be done to see which way the PSA is moving (the physician who did the medical check-up said a second test after four months could be an alternative course of action instead of an immediate biopsy)? If a second PSA test is considered, at what interval should it be done? Assuming the worst case, how damaging would it be to postpone the biopsy until a second PSA?

Hello doctor,

Thank you, doctor. I am confused. You say a biopsy is required now. And also he should take Ciprofloxacin 500 mg twice daily for two weeks and repeat PSA after four weeks, followed by MRI and only then a biopsy if necessary. Please clarify if a biopsy is needed now or after four weeks if necessary.