Digital rectal exam only gets at the "posterior" part of your prostate.........that part next to the rectum. It does not get at the anterior part of your prostate..........that part toward the front of your body. While the majority of prostate cancer is posterior, not all is. Mine was anterior and for years because my PCP felt nothing on digital rectal exam, I thought all was good, while it wasn't. Do not go directly for biopsy unless that is your only avenue. In todays world it should be MRI first. If something suspicious shows up on the MRI and resulting report, get a second read of the MRI to make sure two different radiologists confirm a suspicious region of interest. The radiologist who read my first MRI missed the cancerous lesion. I went two more years before a second MRI read by a competent radiologist found the lesion. Once a confirmed region of interest is found, then do a fusion biopsy of the targeted area of interest. Without an MRI to guide a fusion biopsy the urologist is just randomly sampling your prostate using ultrasound and as far as I'm concerned he's shooting in the dark.