I think a biopsy is definitely a good next step. The ExoDx test is not one of the most accurate any more as the technology has advanced, but it can give a good indication of the presence of cancer.

I had an ExoDx test and the results were elevated (I think the score was 35) which led to an MRI which was completely clear and then a saturation biopsy. The saturation biopsy showed two cores that had a small amount of cancer that was graded as 4+5, and led to a RALP six weeks later. The final pathology report after the RALP downgraded my final Gleason score to 4+3 with tertiary amount of 5.

I would not have been diagnosed as quickly as I was without the ExoDx test so I am a big believer in these newer tests that are more definitive than the PSA test. It's good that you had the test, and given the results I agree that a biopsy is a good next step. I would suggest the saturation biopsy (typically 24 cores) to make sure that all parts of the prostate gland are sampled.