I see that word in your 2024 MRI "prostatitis". It can cause almost everything you have from PSA to elevated pirads. I suspect the prostatitis is the main issue, because it messes with imaging and causes all kinds of error like throwing the pirads rating into a tizzy. Doesn't mean there isn't something there, but it is likely the issue causing imaging to be all over. Doc following right path, follow psa, another biopsy later. That being said for prostatitis sometimes antibiotics help, most times not, sometimes an OTC like liquid drops of sweet wormwood (not plain wormwood) or artemisia annua but just add liquid drops to drink for a month or two, over time it helps about as much as antibiotics which is just sometimes.

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Artemisia annua, also known as sweet wormwood, has demonstrated significant antibacterial activity, particularly against a range of bacteria and parasites.