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”.