Prostatic biopsy or referral to a urologist is recommended if PSA rises above 4.0 ng/mL or if it increases either by more than 1.5 ng/mL/year or by more than 0.75 ng/mL/year over 2 years,294 or if PSA rises by more than 1.0 ng/mL in the first 6 months of treatment or by more than 0.4 ng/mL/year thereafter.2

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