Ok, Ken ... let me know how the MRI goes . Im in Canada ( Vancouver Island ) so we have slightly different approaches here . At 4.5 PSA you should have started to investigate . Why didn't your GP insist on further investigation at 4.5 PSA? Depending on your age, if you are under 70 or so, it is normal practice here to have a work up done starting with the bone scan, MRI, and possibly ultrasound to start with at around the 3.5 to 4.0 range. Biopsies are usually after that if they discover anything on the ultrasound, bone scan or MRI. Also, I had about 3.5 PSA, they would start various bloodwork and a few more PSA tests. If any other tests are negative in tone, meaning that there is a suspect lesion, they would definitely assume a defensive rule and do a biopsy. Anyway, if your age is above 80, they may be a little bit slower in reacting to a 4.0 PSA. PSA generally goes up with age and it is considered around 78 years old to 80 years old they expect your PSA to be 1.0 to 3.5. However it all depends. So age is a factor with the aggressiveness of the investigation. I take it you're under 80 years old?. Keep us in the loop on the MRI and let us know what the doctors have to say. Also it's worth noting that if you're over 75 years old and depending on any comorbidities, doctors tend to go to the radiation route rather than the operation route. If you're under 75 years old and in good shape, an operation is definitely an alternative for you. Anyway, I will pray for you to have great results and let us know. James.