Year 4middle twist
A 54-year-old man with no family history of prostate cancer attends his GP for a routine check-up. He is asymptomatic and has no significant past medical history. He asks about prostate cancer screening. After a discussion about the benefits and harms of prostate-specific antigen (PSA) testing, he decides to proceed. His initial total PSA result is 4.2 ng/mL (reference range: <3.0 ng/mL for further investigation). According to current guidelines, what is the most appropriate next diagnostic step?