Do I have Cancer or Not?

Yes, that does seem to imply you do have cancer, but it can’t be seen by the tests. You could try getting a PSE test. They are 94% accurate in7 figuring out whether or not you have cancer from, a blood sample. Your doctor may know of another test like that. You don’t know right now and that may give you the ability to know. .

I'll definitely order it now, I had no idea a RADS 4 would mean an 80% risk of having cancer. Are there any charts that verify the percentages?

@theanomaly Difinitely there are several sites to gooogle . However the followinnd is a summary . Rads 1 to 5 indicates how likely a suspicious area in your prostate ( as shown on an MRI ) is likely to be cancerous . A Radiologist assigns the score AFTER ANALYZING YOUR MRI .
Pi - RADS 1 VERY LOW RISK -- No signs of cancer .
PI - RADS 2 LOW RISK - Unlikely to have cancer .
PI - RADS 3 INTERMEDIATE RISK .
PI - RADS 4 HIGH RISK . Likely have cancer .
PI - RADS 5 VERY HIGH RISK . Most likely have cancer .
What next : RADS 1 & 2 No treatment recommended .

RADS 3 or HIGHER . A followup Biopsy . Preferably A Transperineal MRI Fusion Biopsy which reduces the chances of infection - possibly Sepsis . And always request a 2nd or 3rd opinion of your biopsy Gleason Score . You should also google what your Gleason score means and your treatment options .
Good Luck . Keep me posted

@theanomaly. A followup to my previous reply . Google " Gleason Score Meaning " This will get you into a number of dropdown sites explaining not only the Gleason Scores but A Cancer Grade and potential treatments
Don't panic , you are on your way to better understanding your condition . An educated patient becomes their own best advocate and eventually make the treatment decision , in concert with their family who should be keep in the loop , best suited to you situation , We are all similar BUT NOT THE SAME . Do not assume what worked for someone else will work for you . Always follow the medical advice of a trusteed Urologist or Radiation Oncologist . And again seek a 2nd treatment opinion . Urologists as Surgeons want to perform Surgery -- Radiation Oncologists want to Radiate . Educate yourself on thhe numerous other FOCAL THERAPY
OPTIONS . Google these and educate yourself -- Ask lots of questions . Never take no for an answer .

Ask lots of questions . Never take no for an answer .

I have taken to heart the advice of all the experienced members on this site yet I do not understand the resistance of the Urologist. Why put me on 6 more months of active waiting when from everything Ive read seems to be a very bad idea. I have both PIRADS 4 and A.S.A.P lacking basal cell markers. I also have a PIRADS 3 lesion. PC can be treated if I catch it early. If I am wrong in waiting I run the very real chance that a clinically significant cancer will take advantage of the waiting period to metastasize and limit my treatment options. I'm hoping they will grant my request for a PSE test and a trans perennial biopsy. We have to know what these atypical cells actually are especially since they lack basal cell markers. I fear these cells are in fact under sampled cancer cells. Leaving them in unknown territory could very well cost me my life.

Get another Urologist.

If it's your preference, tell your urologist that you want to be aggressively proactive and that you're willing to risk unpleasant side-effects to do so. The patient's wishes form a big part of their decisions. Be polite but direct and firm.

After my stage 4 diagnosis, I told my onco team that I wanted to fight (instead of just getting palliative treatments to keep me comfortable), even though I couldn't even sit up in bed yet after the spinal injury, and they took me at my word.

I cant imagine stage 4, its absolutely horrifying. I don't have the level of pain tolerance to survive without going the palliative route. Amazing how many stage 4 survivors and fighters there are. How do you do it? I only hope they find out what I have before its too late. If its in the prostate I can treat it, once it gets out all bets are off.

I hope you never experience stage 4, but you'd be surprised at how manageable it is with the latest prostate-cancer treatments.

Aside from the normal ADT side-effects (which have gotten easier over time for me), quaterly blood tests, more-frequent medical check-ups, and swallowing fistsful of pills every day, many people with stage-4 PCa live basically-normal lives.

My case was unusual because the metastasised tumour compressed my spine and left me paralysed from the ribs down for a while, but even then, I have recovered maybe 75% of my mobility and sensation after a few years, and I wake up most mornings happy, energetic, and ready to engage with the world.

It's not fun having advanced cancer, but it's not the steteotyped object of pity and despair they depict in TV and film, either. It's just something we live with.

Here's an article from last spring about how quickly prostate-cancer treatment has progressed, and how even stage 4 is on the brink of becoming a chronic disease that can be managed indefinitely for many people:
https://www.scientificamerican.com/article/treating-prostate-cancer-at-any-stage/