Your Profile & Risk Factors
(First-degree relative diagnosed before age 65, or ≥2 relatives on same side)
Your PSA Risk Assessment
Advanced Biomarker Tests
If your PSA is elevated (especially in the 2.5–10 ng/mL range), your urologist may order one of the following additional tests before recommending a biopsy. These tests help differentiate between benign enlargement and cancer. They are not available for self-interpretation — they require a lab or physician order.
PHI — Prostate Health Index
Blood Test | FDA-ApprovedCombines total PSA, free PSA, and a special form called p2PSA into a single score. FDA-approved for men ≥50 with PSA 4–10 ng/mL.
PHI <27: ~90% probability of negative biopsy.
PHI 27–55+: Increasing cancer probability (16–50%).
Can reduce unnecessary biopsies by ~30%.
4Kscore
Blood Test | Panel of 4 ProteinsMeasures four kallikrein proteins plus age, DRE result, and prior biopsy history. Reports as a % probability of having clinically significant cancer.
<5%: Very low risk — biopsy may be deferred.
≥20%: Meaningful risk — proceed to MRI or biopsy discussion.
Can reduce biopsies by 36–60%.
ExoDx Prostate / IntelliScore
Urine TestUrine-based RNA test measuring PCA3 and ERG gene expression. Validated for PSA 2–10 ng/mL when considering initial biopsy.
Score <15.6: Low risk; biopsy may safely be deferred after shared discussion with your physician.
SelectMDx
Urine Test (Post-DRE)A urine sample collected after a digital rectal exam measures HOXC6 and DLX1 mRNA. Generates a risk score for clinically significant cancer. Useful when MRI is unavailable or inconclusive.
PHI and 4Kscore perform comparably in validation studies. Neither is clearly superior to the other. Your urologist will select the most appropriate test based on your clinical scenario, availability, and insurance coverage.
Multiparametric MRI (mpMRI) & PI-RADS Scoring
If your PSA remains elevated after confound exclusion and secondary biomarker evaluation, an MRI of the prostate is typically the next step — usually before biopsy.
A PI-RADS 1–2 result does not fully exclude cancer. In approximately 1 in 10 patients with a negative MRI, clinically significant cancer may still be detected on biopsy. If you have additional risk factors (elevated PSA density, abnormal DRE, strong family history), your physician may still recommend a systematic biopsy.
Validated External Risk Calculators
These physician-facing risk calculators are endorsed as supplementary tools. Your doctor may use them to further refine your risk estimate:
Physician Brief
Download a summary of your PSA data, risk tier, and secondary biomarker information to bring to your next physician appointment. This report is clearly labeled as a patient-facing risk estimate — not a clinical diagnosis.