The more usual use of it is in instances where PC is suspected but previous biopsies had not revealed anything.
This was the case with a friend who had one last year, and why I'll probably have one next month. My last biopsy was all clear.
Transperineal has less risk of infection, but slightly more risk of urinary side issues.
You could obtain a "freePSA" test, but Considering your prostate size, your PSA figure and PSA density of .11 doesn't seem unusual.
Has there been an upward PSA trend?
There is no "normal" PSA reading. For example someone could have PC with a PSA under 3, or someone might not have it with a reading considerably higher.
The trend in PSA readings is more relevant than one individual number, and most look for any sudden trend rise defined as three higher peaks.
PSA Density: PSA readings are meaningless without factoring in prostate size. The prostate naturally produces PSA, and the larger it is the more PSA is produced: "PSA Density" is one simple calculation of the ratio of PSA to prostate size which by some criteria should be less than .15.
A "free PSA" test will indicate the % of PSA being produced by normal means and provide a probability of PC. It's often used when the PSA is in the gray area between 4 and 10.
Very large proportion of PSA readings in the range of 4 to 10 are tracked down to benign causes.