The rate of change of PSA over time is called the PSA velocity. In general, a normal prostate gland has a change in PSA of about 0.3 to 0.75 units per year. This is due to the prostate aging and enlarging. Any rates above that in a year may mean that prostate cancer is present.

Doctors focus on the rate of change because there is no reliable PSA number that defines normal or abnormal. Men with a PSA below 4 can still have cancer. And men with a PSA higher than 4 often do not have cancer.

So, even though your PSA is about 4, which is considered normal, its rate of change is of some concern.

The question is, "What do you do now?" I suggest that you talk to your doctor and consider being retested in four to eight weeks.

If your PSA is still in the 4 range, then you should consider a biopsy. This is especially true if there are no other causes for the PSA to be elevated. An infection in the prostate (prostatitis) is one example.

If the biopsy comes back positive for cancer, then there will need to be a lot of discussion about what to do next.

Prostate cancer can be treated many ways. You and your doctor must examine your personal medical and lifestyle issues before deciding on the best plan of action for you. Whether to start treatment immediately and what treatments to consider will take into account:

• The extent of your cancer
• The chances that your cancer will grow and spread rapidly
• Your age and life expectancy
• Any health conditions that would increase the risks of surgery or other treatments
• Your willingness to risk side effects

Recent studies that have questioned the benefits of the PSA will be part of your discussion. You can learn more here.

You also asked about the risks of a biopsy. A prostate biopsy can cause blood to appear in the urine and semen. The blood in the semen can last up to two weeks.

An infection with a fever is a more serious risk. Rarely, the infection can affect the urine and make its way into the blood stream. This is a potentially critical situation.