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The rate of change of your PSA (velocity) and the absolute value are very problematic.  There are cases of prostate cancer that are not able to be detected with traditional transrectal biopsies. There are several centers in the country that are using advanced MRI techniques of the prostate to detect these cancers.  Another option would be a transurethral resection of the prostate in order to get to this tissue that is not reached by transrectal biopsy.
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