Hello and thank you for using HCM for your health questions! Short answer: Not necessarily you need a biopsy. Detailed answer: The normal PSA level is up to 4 ng/mL. In this context your PSA level is high which means that you need to monitor it regularly. Elevated PSA can be caused by other problems not related to cancer. The most other common causes, as you might know, include an infection of prostate gland (prostatitis), urinary tract infection and benign prostate hyperplasia. When the PSA level is elevated then one should exclude these conditions before considering another biopsy. Your doctor might want to do a digital rectal examination in order to look for any lumps or unusual structure in prostate gland. You state that your prostate is enlarged but clear (probably this is the cause of elevated PSA), and you have done all other examinations. You can also get examined for an infection of prostate/urinary tract and then monitor again PSA levels. Please note that about three quarters of men with elevated PSA levels do not have prostate cancer in biopsy. However, if all other explanations fail to make sense of your elevated PSA level then probably another biopsy is the right thing to do in order to be sure. Please note that in many cases, biopsy detects small, slow-growing tumors that do not need to be treated at all and your doctor should be aware of this in order to avoid unnecessary over-treatment . I hope that my answer will help and I wish you good luck!