I also had pirad 3 MRI even though my tumor in the end was 3+4. If the biopsy shows a tumor that is what you should go by.

Given the extent of the tumor, you will likely want to treat it. Your next steps will likely be Decipher and/or Artera AI. A PSMA may not be necessary with a 3+4 (and probably not covered by insurance). Given your family history, I would also do a genetic test to check if you have BRCA or ATM mutations.