I had a TRUS biopsy and mine was MRI-guided. In this process, the person doing the biopsy has the ultrasound imagery with the MRI imagery overlaid resulting in much better targeting. I had a well defined lesion they were targeting plus sampling of other areas of the prostate. Not sure what you mean by a "no concerning cancer lesions" but realize a TRUS biopsy only samples a very small area of your prostate and may well miss cancer areas. I regret not having sedation as mine was painful as hell! If I had it to do over again, I'd opt for a transparenial biopsy with sedation. And yes, ALWAYS get a second opinion from a well-known, respected medical professional who specializes in this field. You'll find that many of the very best in the country offer virtual consults. Best wishes!