Unfortunately the PSA is not a very good test for prostate cancer.
High PSA readings seem to indicate that the prostate is under stress,
and that is about all. Could be BPH, prostatitis, cancer, or something
else. Screening men for cancer by using PSA when other symptoms are
absent is no longer recommended.

But prostate cancer is the most common cancer in men, and some forms
are very aggressive. So the doc will want to know what is going on,
and PSA is one tool in the arsenal.

A positive biopsy is pretty specific for cancer, but if it is
negative, it is a lot less clear what is up. The probes might have
missed the cancer if it is small.

So for the docs,  it is a balancing act... what tests to do when they
pose risks and it is known that they are not that good.

I'm pretty sure there are protocols, and that they are refined as time
goes on.  

One indicator is "PSA density". If the PSA increases with time but if
the size of the prostate also increases, in step, then that suggests a
non-cancer cause.

Discuss these issues with your uro. They are all well aware of the
risks and tradeoffs.

As far as the insurance goes, I think a responsible person would have
that. Did you think you would never get sick?

Ed

I might get tested once a year-and cut expenses in half--you should get
medicare soon-I think it pays for biopsy

Prior to having a TURP in 1998 my PSA went from 4 to 17 over a period of
several years.  My PSA has never been much less than 4.  Had two negative
biopsies during this time.  After the TURP in 98 it dropped back to 4 and
has remained there to this day.  My uro says an elevated PSA  is a fairly
common result of an enlarged prostate.

Don