There are several ways to indicate a likelyhood of PC rather than BPH.
PSA3 and Saturation biopsies have already been mentioned in replies to your post and are effective.
Free PSA, PSA doubling time, and PSA velocity are also indicators.
Scans such as endo rectal MRIS and color doppler ultrasound can identify most tumors, but you need a biopsy to really know for sure.
If tests such as free PSA, PSA3 and your PSA doubling time indicate PC then I would either get a saturation biopsy or a color doppler targeted biopsy.
I was one of those guys who went through 13 biopsies before anything was found. Color doppler or saturation biopsy would have picked it up years sooner.
I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%
I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.
in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.
2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.
Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.
Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.