1. PSA value > 4.0 ng/mL
2. Suspicious findings on DRE : the presence of nodules, induration, or asymmetry
3. Persistently abnormal or rising PSA levels
4. Very low percentages of free PSA (< 13%)
Variety of other PSA-based parameters ( PSA velocity, PSA density )
* Contraindications :
1. The surgical absence of a rectum
2. Presence of a rectal fistula
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