Did you have an MRI Fusion biopsy, where the MRI is fused with the ultrasound so that precise targeting of the region of interest can be done? Second a 0.2mm lesion is very small. Radiologists seem to get more concerned at about 1cm or greater. PIRAD-4 while it is greater than PIRAD-3 (which is equivocal or indeterminant) isn't as great as PIRAD-5. So if you have cancer it's in a very formative stage in my opinion. You have time. Get yourself educated because you will become your advocate with these doctors. Remember, they work for you. Best educational material I found besides Peter Walsh's book is at Prostate Cancer Research Institute website. pcri.org. Go there immerse yourself in all that it has to offer. I spent at least 150 hours watching videos, making notes and getting myself educated on what I had and what treatment options were available. Others have mentioned the new PSE test. See if you can get your urologist to order it for you. The claim is with 90 to 95% accuracy this blood test will tell you if you have prostate cancer. I think the reason Active Surveillance is being suggested is because there's still uncertainty about your situation and they want to watch it to see what transpires. Prostate cancer, unlike other cancers is very slow growing, unless it's highly aggressive. And should it be, I would think you've found it at a very early stage given the size of the lesion. You need more information in my opinion in order to make informed decisions about a diagnosis and treatment. And once you get there...........get a second opinion or even a third opinion for centers of excellence before you decide on a course of action. You most likely have plenty of time in order to do all of that. This is typically the case.