@oinc2526 You have probably been on "inactive surveillance" since 2021 if all of your previous PSA tests had been around 1 or less. BPH does not double PSA in 1 year and it has never really gone down since. You definitely want a Urologist referral since work insurance (at 60 assume that is what you have) is more likely to approve the tests / procedures ordered by a urologist. They may go straight to MRI with that history. Biopsy is required for diagnosis of prostate cancer. You still may have trouble with your insurance since PSA is below the 3.0 in their cookbook. Any denial is likely to be approved on appeal if cancer is found. I included my biopsy report in all of my appeals (to 3rd parties) and all got paid.