Good PSA/MRI active surveillance results still require fusion biopsy?

Posted by oct172024 @oct172024, Oct 17 9:00am

Hi all -newbie here. Will be age 67 March 2025. History:
03/2023: PSA from 3.1 to 9.
04/2023 MRI: 1.9cm PI-RADS 5 lesion and 0.6cm PI-RADS 4 lesion.
07/2023 MRI Fusion Guided Prostate Biopsy: both lesion locations benign. Of 18 cores, (1) at another location was Gleason 6 involving 10% tissue.
10/2023 Follow-up GPS Report: GPS=18, "19% likelihood of adverse pathology at Radical Prostatectomy"
Urologist: "Great results, commence Active Surveillance".
06/2024: PSA = 3.7
06/2024 MRI: both lesions stable/unchanged at 14mos. after previous MRI. MRI was on a new/improved unit -told results are more accurate.
09/2024: PSA = 1.9
Regardless of the recent normal PSA result and unchanged MRI, my urologist wants another fusion biopsy.
My Question:
Based on my good recent results, is another fusion biopsy an unusually conservative decision? Why would non-invasive options such as free PSA test, digital rectal exam, MiPS test not be used to collaborate/confirm my results? The fusion biopsy seemed a foregone conclusion regardless of results, -seems very conservative based on no indication of advancement at 14 mos between MRI's, and low PSA. Appears to be very slow advancing, therefore assume a low risk to continuing active surveillance until next year's MRI. What is the chance of a slow-advancing cancer suddenly going zero to 60 over 1 year?
Thanks for your time.

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oct172024 | @oct172024 | Nov 26 2:56pm

OP with my fusion biopsy update:
As projected, the fusion biopsy confirmed my MRI -no change in 14mos.
18 cores, 16 benign. Result for core at same location that had a positive result for last biopsy:
Gleason 6 (3+3), Grade Group 1, Involving 5% tissue (vs 10% 14mos ago).
Another core reported "Prostatic tissue with focus of small atypical glands, suspicious for adenocarcinoma".
Extraprostatic Extension from 18% to 7%, and Seminal Vesicle Involvement from 1% to zero.
My urologist was happy with the biopsy result -based on that they plan no further MRI's/biopsies and will monitor PSA, with the first test 9mos out.
After this one, I hate prostate biopsies more than ever! Relieved to be done w/them for now at least.
Guardedly optimistic, since urologist confirmed that a baseline is now established for very slow advancement and that it's rare to go "zero to 60". He's satisfied that the two lesions (PI-RADS 4/5) aren't acting like it.
Had many Q's and discussion topics prepared but with the "great results" and my urologist's positive projection, I decided to thank him then get out of there to start enjoying putting all this out of my mind for now.
This is a great forum -I again thank handera and the others that responded to this thread, and wish everyone the best. I realize my journey can start again -thankful for every day.