I am not posting much these days, and others have given you a lot of valuable advice here - just an opinion from me too and who knows really? The stringent medical follow-up regularly seems to be the main thing on your side here with regards to your brother.
All I can really say is that my husband with a PSA of 3.5 (at 48 years at the time), DID have prostate cancer (multi-focal but confined to 2 specific areas close together), however the (12 core) biopsy picked up only 1 x 5% positive in 1 core and all others negative. As you know, biopsies can miss small cancers. We have exactly the same dilemma here with my 54 year old brother-in-law who had a PSA in January 07 of 4.0, refused follow-up or repeat anything, and is only NOW getting his PSA re-checked (so he tells his mother - my mother-in-law). Even now, I am not so sure he is following this up at all, and this is extremely worrying. He still has not seen a specialist, despite all efforts of the rest of the family. So maybe the thing is to check out your brother's doctor and make sure he is experienced (an expert) in the area - if so, this may not be a concern if he is being monitored carefully, but to me this PSA reading seems high in light of his age. My understanding is that a PSA for a man of 49 should be less than 2.5 but of the higher readings not all are cancers (my husband was told his odds were 50/50 of having cancer pre-biopsy).
I reckon the good news with your bro is that he is having regular testing, therefore he is being monitored, and Tamu's words are wise on that point.
If you check out his doctor (privately - reputation etc) maybe a second opinion on his PSA's and tests so far would be helpful to suggest to him? I think with this disease, and knowing his family risk now, that you will probably always worry about
him, but keeping him to his tests and appointments so that if there is a problem it can be addressed early, is all you can really do. And that seems what you are right into here with your questions.
Hope you do not mind me chipping in here - I am ultra sensitive to high PSA's in younger men - it makes my heart pound with anxiety... Good luck to you, and also in watching over your little brother. cheers, Lana
Lana posting for husband CJ (49 years). First PSA 3.5 (Nov 06). Open Radical Prostatectomy on Tuesday 17th April 2007. Gleeson 3 + 4 = 7. Confined to prostate. PSA 0.01 (June 07).