My situation is quite similar to your situation:

06/17/2022: PSA = 5.0
11/01/2022: PSA = 5.1
05/31/2023: PSA = 7.8

10/01/2023: mpMRI found three lesions
Lesion#1 - 2.1 x 1.1cm PI-RADS 5
Lesion#2 - 0.7cm PI-RADS 4
Lesion#3 - 0.9cm PI-RADS 3

10/16/2023: MRI Fusion guide biopsy of 15 cores, found:
5 cores w/5%-10% (3+3)
2 cores w/20% (3+4) involving 10%-20% pattern 4
Decipher Score = 0.22 (Luminal A - Differentiated)
Clinical-Genomic Risk Model dropped risk from “Favorable Intermediate” to “Low Risk”
- AS recommended

11/01/2023: Began running three 5K’s (~9 miles) per week and prostate healthy diet.

02/06/2024: Lost 25 lbs since 10/16/2023 biopsy and PSA = 5.95
05/15/2024: PSA = 5.87 & 6.57 (taken 15 minutes apart – different labs)
08/14/2024: PSA = 6.20
10/11/2024: PSA = 6.81

10/16/2024: mpMRI found:
Lesion#1 reduced to 1.9 x 1.1cm with “T2 hypointense focus” reduced to “mild T2 hypointense focus”” and DWI/ADC signal reduced from “moderate abnormal” to “mild abnormal”
Lesions#2 and #3 could no longer be “visualized” in follow-up MRI (suggesting potential regression).

I will be discussing my latest mpMRI with my urologist in my upcoming appointment in 7 weeks.

In the interim I formulated all my PCa data and information into a complex and lengthy question at https://www.perplexity.ai and received a comprehensive answer, complete with many referenced sources, that can be summarized as:

“The reduction in size and decrease in signal abnormalities suggest a potential stabilization or minor regression of Lesion#1, which is generally associated with a better prognosis.

"The changes observed align with lower PRECISE scores (1-3), which have a high negative predictive value for disease progression.”
https://www.europeanurology.com/article/S0302-2838(24)02232-2/fulltext
“The observed changes support continuing active surveillance, as they suggest a stable or slightly improving condition."

"Regular follow-up mpMRIs and possibly repeat biopsies will be crucial to monitor for any future changes or progression."

My urologist has already suggested that he will only recommend another biopsy IF the non-invasive testing suggests progression. In other words, I don’t expect him to recommend another biopsy (at this time), based on my current status.

In my case, my Decipher score played a large part in my decision to pursue AS AND I believe my aerobic exercise program is the primary reason for the stable to minor regression observed during the past year (based on multiple RCTs demonstrating the benefits of aerobic exercise in slowing PCa progression).

I will be continuing my AS plan for another year, without undergoing another biopsy.

All the best with your decision.