My urologist admits that the PSA test is nearly worthless, but we both agreed that it would be better to do a biopsy and be sure. Then a few years later he tells me the biopsy isn't really a sure thing, forgot the exact percentage, let's say 90% for the first one. So he suggested a second one to raise the coverage to 95% or so, which also came back negative. Then a few years later he suggested doing a third one, this time to raise the certainty to close to 100%, that came back negative as well. So I'm done with their faux science and have given up on PSA testing altogether.
Since I was in my early 40s when my PSA started shooting up, they wanted to be sure there wasn't any cancer. As you get older the risk becomes less because even if you get the non-aggressive form of prostate cancer it takes something like 20-25 years to kill you anyway, so you'll probably die from something else before the prostate cancer gets you.
If you like having a dart gun shot up your ass 10 or 12 times, and pissing and ejaculating blood for a few days, I highly recommend the prostate biopsy.