@katebaker What was the PSA before it was 6 and how long ago? If it was over 3 on a PSA test a year ago there is a good likely that it is BPH. However, if it was 2 than it is still double and more likely to be cancer. If the high PSA is due to an infection, it usually falls back close to the previous level after a course of antibiotics. Was there about a month between the first and second test? As far as biopsy the standard biopsy randomly samples less than 1% of the prostate. It is very easy to miss cancer unless the prostate is full of lesions. That is why getting an MRI first and a fusion or MRI biopsy to sample any suspected lesions found with the MRI is much better at providing a definite answer. Also, usually no biopsy if MRI finds nothing.