60 yr old psa increased from 2 to 3.97 in 1 yr, what should i request

A referral to an urologist if your insurance requires one. Try to make an appointment at a center of excellence at once. They will likely do a PSE or IsoPSA before deciding on MRI or biopsy.

Have you ever had a problem with BPH or an enlarged prostate?. Did you go in and get your PSA test after riding a bicycle?. All of those things can cause your PSA to be a lot higher than it should be. It still is around normal for your age. As mentioned a PSE test would be very useful to know whether or not to do a biopsy.

I agree with the other commentors about finding a urologist and getting a PSE test before a biopsy. When in early 2024 I had a rising PSA that went from 2.8 to 4.25 over about 15 months, my urologist followed a pretty convential path and ordered another PSA test and an MRI (3T) with contrast. The MRI was a piece of cake, but then I'm not claustrophobic. The MRI tech gave me an IV, and then I lay in the MRI for about 20 minutes with a set of headphones playing music. The hardest part was just trying to lay still. The MRI showed a lesion and the radiologist report (which I got at the portal of the lab which did my MRI) said it was PI-RADS 4 (high risk of cancer). Interestingly the follow up PSA had come down to 3.24. I got a 2nd reading of the MRI results and the 2nd radiologist also gave me a PI-RADS 4 so I went ahead and got a fusion biopsy (which gives high confidence they biopsy the actual lesion). The biopsy found plenty of cancer, so the last drop in the psa was a false signal. I guess my point is while there are various ways to proceed, just be sure to follow up on it. It might well be nothing, but if it is prostrate cancer you'll have many more options finding it early as compared to late. BTW, I'm not a medical professional but just a layman, so take my comments with a grain of salt. Best wishes.

I can't offer any more advice than what's been offered here: ask for a PSE test to give you a good highly accurate blood test to see what's up.

Let me repeat what my urologist said to me before everything started: "I have patients with a high PSA and no cancer and those with a low PSA that have cancer, which is to say that the PSA in and of itself is nothing to be concerned about". What we often refer here to as your "check engine light" - so go get it checked and don't worry about it until it's time to worry and, if that day comes, we are here for you.

I agree with the others. Get a PSE test with the PSA. The PSE test is purported to be 94% accurate while the PSA test, alone, is 55% accurate.

Agreed Go to a Urologist and get a PSE.