My husbands PSA levels are all over, 4 to 9. He has found that when his pouch is acting up and he has his PSA drawn, it is high. My husband after talking to his doc's and doing a lot of research, opted for a MRI rather than the traditional biopsy. Reasons why, risks of damage to pouch, less invasive, and lower risk of infection. He takes Cipro ans sometimes Flagyl as needed, which is a few times a week.