You sound a lot like me! Just watched my PSA go from 5.75 in 2016 to 17.5 in late 2022. Didn't want to do a biopsy but did 4 MRIs over that time. Saw a tiny lesion of about 5mm (older Tesla machine) grow to about 11mm. At that point PSA was 12.3 and i still resisted a biopsy. My thoughts were that once you are on that track with an elevated PSA and visible lesion on MRI, you were destined for the knife or radiation. both of which terrified me.

I am very familiar with the short-comings of the PSA test and used that as an excuse. However, I did know that in the vast majority of cases, high levels of PSA equate to greater chance of mets. Sure someone may get to a PSA of 50 or so with none but they are the outlier. Dr. Shultz of PCRI.com fame mentioned a few of these cases in a symposium I listened to.

When my PSA got to 17.5 late 2022, I went ahead with a biopsy. I knew if would mean treatment but was also cognizant of the pain with a prostate cancer death as my father passed away from it.

I went with proton beam therapy and now know that my fears of treatment were way, way overblown. No ED, no meed for meds and came away wishing I had moved earlier.

Ultimately, you have to decide what works for you. Have you at least done an MRI?

Wishing you the best.