Is a biopsy only way to diagnose prostate cancer?

It is imperative and time is of the essence.

I'm not aware of any 100% way to determine if one has prostate cancer. If PSA is over 10, then there is a 50% chance it is cancer. An MRI can look at the lumps and give a more accurate percentage (but still a percentage). If a biopsy runs through the cancer lump, then you can be sure (100%). If the biopsy sample misses any cancer spots it can come up "negative" even though there is cancer in the prostate. A biopsy guided by the MRI and ultrasound (TRUS) is your best bet at making sure you are hitting the right lumps. A PET scan is not as detailed as an MRI or a CT but, because it uses injected tracers, it can help spot prostate cancer that has spread throughout the body. https://www.cancer.org/cancer/types/prostate-cancer/detection-diagnosis-staging/how-diagnosed.html

I had a rectal. Piece of cake. No pain. Walk in, walk out. If you have a weak immune system perineal may be the way to go. And I've had HDR brachytherapy, so I've done over 30 perineal needles.

From all the men I know personally - and the guys on this thread - you are truly an outlier.
But a combination of a great urologist and your grit made it an unmemorable experience. Good for you!

A PSMA PET Scan would detect prostate cancer, but it is not typically used as the first diagnosis method, and most doctors and treatment centers will require a biopsy confirmation of prostate cancer before considering first treatment options (radiation, surgery, etc.). It is also possible that your insurance would not cover a PSMA PET Scan as an initial diagnosis method, as the PSMA PET Scan is usually used to detect and monitor metastases (PC cell growth outside of the prostate). Before a biopsy is performed, a multiparametric MRI can be performed by a prostate cancer treatment center to assess the likelihood of prostate cancer and the need to undergo a biopsy. If required, getting an MRI guided biopsy from a prostate cancer treatment center of excellence is a low risk procedure. With the results of a biopsy and decifer test (genomic test of cancer tissue to assess aggressiveness), you and your doctors can discuss any needed treatment options.

I recommend continuing to research options for the initial detection of prostate cancer and potential PSMA PET Scans for initial diagnosis and cost, as I am only a patient and not qualified to provide advice. If it were me, I would contact a prostate cancer treatment center of excellence, such as Mayo Clinic, and receive from the best possible doctors information about all initial diagnostic options.

cstrutt52, Yes, that was my experience too "Piece of cake". I put off having the TRUS biopsy for months before I could get up the courage. My fear was basically the idea of having 12 needles inserted where the "sun don't shine" plus reading postings on the internet from guys with painful experiences.

But for me, it didn't hurt at all, he applied an anesthetic before the actual needles, so I never felt the sensation of a needle going in. Then there was just an odd internal feeling each time he fired the needle, similar to being snapped with a rubber band. Actually the antibiotic shot the nurse gave me before the procedure hurt the most and was tender for several days.

My urologist had 10 years prior experience in a VA Hospital so maybe there was a skill factor involved. If I had it to do over again I would have saved several months of stewing over it if I had just gone ahead and done it. Fortunately, in my case, that delay didn't change the outcome.

My experience as well... no pain with transrectal biopsy. Only discomfort was having an ultrasound probe up my ass, but I've had worse with digital rectal exam.