A 68-year-old's prostate tests are pointing in opposite directions. Here's what a doctor says to do

Dear Doctor Roach: I am 68 years old and have an enlarged prostate and benign prostatic hyperplasia (BPH). I’ve been taking tamsulosin for about seven years. My PSA level has slowly creeped up and was recently measured at 4.5 ng/mL. My doctor did a 4Kscore test, and it was rather high at 49%, indicating a higher potential for aggressive prostate cancer. The digital rectal exam (DRE) was normal. An MRI came out low, at PI-RADS score of 2.