Return ONLY valid JSON. No markdown. Based on 7 medical records: DOCUMENT: PSA by Year.docx (Lab Result) Date:...

{
  "bottomLine": "Your PSA has shown a steady upward trend over 5 years, rising from 1.9 in 2020 to 4.22 in October 2025, now exceeding the normal range. The concerning pattern includes both the rising PSA level and a low free PSA percentage of 14%, which may indicate higher risk for prostate cancer and warrants further evaluation.",
  "keyFindings": [
    "PSA has more than doubled from 1.9 ng/mL (2020) to 4.22 ng/mL (October 2025), showing consistent upward trend",
    "Most recent PSA of 4.22 ng/mL exceeds normal range (reference <4.0 ng/mL)",
    "Free PSA percentage is low at 14% (both 2022 and 2025), which may suggest higher risk for prostate cancer",
    "PSA velocity shows concerning pattern with increases: 2020→2022 (+1.7), 2022→2023 (-0.37), 2023→2024 (+0.72), 2024→June 2025 (+0.15), June→Oct 2025 (+0.12)"
  ],
  "gaps": [
    "No prostate biopsy results available despite elevated and rising PSA",
    "Missing digital rectal exam (DRE) findings from urologist",
    "No prostate imaging studies (MRI, ultrasound) documented",
    "PSA density calculation not available (requires prostate volume measurement)",
    "No family history of prostate cancer documented",
    "Missing urologist consultation notes or recommendations for next steps",
    "No documentation of symptoms (urinary changes, pain, etc.)"
  ],
  "questionsForDoctor": [
    "Given my PSA has risen from 1.9 to 4.22 over 5 years with a low free PSA of 14%, do you recommend a prostate biopsy to rule out cancer?",
    "What is my PSA velocity and PSA doubling time, and what do these calculations suggest about my risk?",
    "Should I have a prostate MRI before considering a biopsy, and would you recommend a standard biopsy or MRI-fusion biopsy?",
    "What is my prostate volume from digital rectal exam, and what is my PSA density (PSA level divided by prostate volume)?",
    "Could the rising PSA be explained by benign conditions like prostatitis or enlarged prostate (BPH), and how do we rule those out?",
    "Based on my age and PSA trend, what is my estimated risk of having prostate cancer, and what risk category would I fall into?",
    "If biopsy is recommended, what are the risks and what happens if cancer is found versus if it's not found?",
    "Should I be tested for genetic mutations (BRCA1, BRCA2, ATM, etc.) given the PSA pattern, especially if there's family history of cancer?"
  ],
  "timeline": [
    {
      "date": "2020-02-06",
      "event": "Baseline PSA: 1.9 ng/mL (normal range)",
      "source": "2020 PSA.png"
    },
    {
      "date": "2022",
      "event": "PSA increased to 3.6 ng/mL, Free PSA 14.4% (still within normal range but rising)",
      "source": "2022 PSA.png"
    },
    {
      "date": "2023",
      "event": "PSA: 3.23 ng/mL (slight decrease from 2022)",
      "source": "2023 PSA.png"
    },
    {
      "date": "2024-04-19",
      "event": "PSA: 3.95 ng/mL (approaching upper limit of normal)",
      "source": "2024 PSA.png"
    },
    {
      "date": "2025-06-30",
      "event": "PSA: 4.1 ng/mL (first time exceeding normal range, flagged as high)",
      "source": "June 2025 PSA.png"
    },
    {
      "date": "2025-10-07",
      "event": "PSA: 4.22 ng/mL, Free PSA: 0.61 ng/mL, % Free PSA: 14% (elevated total PSA with low free PSA percentage)",
      "source": "Oct 2025 PSA.png"
    }
  ],
  "cancerSummary": {
    "type": "Prostate cancer screening - no confirmed diagnosis",
    "stage": "Not applicable - no cancer diagnosis confirmed",
    "biomarkers": [
      "PSA (prostate-specific antigen): 4.22 ng/mL (elevated)",
      "Free PSA: 0.61 ng/mL",
      "% Free PSA: 14% (low percentage suggests higher cancer risk)"
    ],
    "treatments": [
      "No treatments - currently in monitoring/screening phase",
      "Next step likely: urologist consultation for possible prostate biopsy or MRI"
    ]
  }
}