Yes ! My thoughts exactly . I'm learning that many people have great insurance where they can have input into the treatment process and some can even choose which facility they can use . I think Kaiser has a set treatment routine for prostate issues - first you get a blind biopsy ( after an elevated PSA reading ) , then you get a prostate removal if your Gleason is 7 or higher . No wiggle room for
watching or treatment options ..... I think I'm just going to have to live with my high PSA reading ( 11 ) and hope for the best .....What's really shocking is that there isn't a urologist in the country that will take cash payments (even for a consultation) they are all demanding insurance only - maybe it's malpractice worries ? I don't know .

You are spot on! An mpMRI PRIOR to an initial biopsy should be mandatory!

First it provides information as to where to focus an ultrasound fusion guide biopsy AND it establishes an initial set point to compare to future mpMRI’s and biopsies that you may need to get if treatment is postponed for any reason (especially if one opts for AS).

I suppose some docs would say it’s not necessary if your PSA is sky high…as they are probably assuming a sky high PSA definitely means one has high grade PCa.

But if that’s the case you’re probably going to end up having a PSMA-PET scan after your biopsy to determine spread.

I don’t know if insurance companies will cover the cost of a PSMA-PET scan, w/o a PCa confirmatory biopsy…but I doubt it.

In any event, it seems to me a good doc is going to get an mpMRI PRIOR to biopsy…I’d go elsewhere if mine were to decide to “fly blind”.