BPH Can cause an enlarged prostate, which then can cause a high PSA. The thing is the MRI did find Three possible lesions with a PIRADS 4 score. They do not guarantee that there is prostate cancer, but they do make it likely.

If you could get a PSE test, it would be able to tell you whether or not there was prostate cancer in your system, If it says no, then you don’t need a biopsy. It is 94% accurate. Just another option, Not sure if you have that available, but it is FDA approved.