Hi and welcome to Healthcaremagic. Thank you for your query. I understand your concerns and I will try to help you as much as I can. He should definitely accept biopsy. This is not painful and this is the only way to rule out the worst scenario, However, elevated PSA indicates in most cases prostate issues such as prostatitis or hypertrophy and rarely it may be sign of STD infection. Tumor is not first thing to think of but should be considered. He should avoid intercourse for till symptoms persist and drink plenty of fluids. ut as I said, it would be good to do prostate ultrasound and biopsy to rule out prostate tumor or hypertrophy and further treatment depends on these findings. In most cases it can be controlled with medications but sometimes, in case of tumor, open surgery is required. And severe benign hypertrophy may be managed endoscopically so you should consult urologist about appropriate options. I hope I have answered you query. If you have any further questions you can contact us in every time.Kindly regards. Wish you a good health.