Psa up from 7 (avg.) to 11 on consecutive tests. Fpsa estimated at <10%. Two negative biopsies (2005 & 2009). Prostate @68g & bph. Now what?

Elevated PSA. Now the specialists may disagree, but my advice as a family physician is that the most common cause of mildly elevated psa is benign prostatic hypertrophy. In 2011 the United States preventive services task force advocated against any kind of routine psa screening. With 2 negative biopsies, i wouldn't do anything more than check your psa once a year and see a urologist if it goes over 20.
Not an easy answer. This is a controversial area. Making the diagnosis of ca of prostate is one thing and treatment another. The aggressiveness of the pursuit is dependent on the patient. In an octogenarian or a patient with extensive co- morbidities treatment is unlikely to result in survival benefit and is associated with it's own set of issues. With two negative biopsies we are not dealing with high volume disease.
See below. You are under urologist(you say prostate is 68cc-not grams-& had biopsies2Xs tells me you are under urol. care)care.If the free PSA is less than 10% the statistical probability of prostate ca.is 55%.Your last biopsy was 2009.You say BPH tells me no nodules are felt.You are only 60yrs.old.If you are in good health and were my pt. I would do what we call a 12 segment biopsy.Talk to yr.urol.Good luck.