Biomarkers have been developed to help define the probability of prostate cancer prior to proceeding to biopsy. The goals of the biomarker tests are to decrease the risk of unnecessary biopsies and increase the likelihood of cancer detection, without missing a significant number of prostate cancers. The biomarker tests may be most useful in men with PSA levels between 3 and 10 ng/mL. Currently, the NCCN recommends consideration of percent free PSA (%fPSA), Prostate Health Index (PHI), and 4Kscore in patients with PSA levels > 3 ng/mL who have not had an initial prostate biopsy. For individuals who have had at least one negative prostate biopsy but who are thought to be at higher risk for prostate cancer (increasing PSA), the NCCN recommends %fPSA, PHI, 4Kscore, PCA3, and ConfirmMDx. At present, no test has been established to be superior to another. Prior to having such studies done, it is advisable to ensure that your insurance company covers these tests.