Went thru the exact same thing before I was on Medicare. BC/BS are the absolute WORST and said the scan has not been shown to ‘statistically’ change outcomes - COVERAGE DENIED.
But it was MY life on the line so I just paid for it - like $7500 or so.
My MRI did not show all that yours did, except to say that there was a mass inside the gland - no extracapsular/seminal vescicle involvement. And still I am in the middle of salvage therapy 5 yrs later after surgery.
It’s just my humble opinion but you really should have the PSMA even if you have to borrow the $$ or take a home equity loan.
Your DRS really need to see what’s going on in order to perform the proper treatment. The $$ you spend now is truly an investment in the rest of your life. Best of luck!