@housedivided14
I think I had mentioned this in previous post that you don't have a diangosis yet. You may not even need radiation or surgery. Many things cause PSA to rise like BPH, infections, irritation, etc.

You mentioned biopsies. There are two main ways they are done. Transrectal, and Transpernial.
Transrectal usually is not with anesthesia but not saying it is not ever done that way. Thus you are awake and the biopsies are done with your awake. Some tolerate this very well with little discomfor and some have a lot. It is why you need to do what is best for you not what others did.

For me I wanted mine done transpernial and with anesthesia. It is not deep anesthesia but you will not be aware of the procedure. I had no pain prior, during, after and don't remember a thing.

Transrectal also comes with increased chance of infection. The infection can be serious and require hospitalization (from my Mayo urologist). The infection rate increases from 1-2% depending on your medical providers informatoin they use. I was given 2% increase others have listed 1%. For me I did not want an increase in infection and the transpernial infection rate is so much lower my uroloigst says very very rare.

The rectal swap is to see what bacteria and germs are inside your colon, etc. This gives the surgeon, uroloigst, etc. what antibotics to give you.

I would look for a uroloigst that does the procedure tanspernial with anesthesia. With that like I decided for me was best you will have no pain, not aware of procedure and removal of the 1-2% increase in infection rate.

Don't be stressed out. We all went through the nervousness and stress of this. You are starting your journey that most of us now have completed and can guide you of what we did and why.

You don't even have a Gleason Score (Degree of your cancer) yet or diagnosis of cancer. So your journey may end with your biopsies. For me I wanted to know if had cancer and doing the biopsies was not something I hesitated with. And would not even know I had then unless I knew I did.

If your biopsies come back postive now look into (with discussions with your urologist and R/Os,) additiional test like Decipher, PSMA. But don't worry about them right now as your biopsies may come back negative and you will not be joining our group. Your PSA is still quite low and very close to normal. Without seeing how much it has increased over time and how many test you have had it could be nothing more that HPH or an infection, irritation.

Think positive and look at biopsies as something to give you the information you need not something you should fear. And chose transpernial with aneesthesia if worried about pain and increase infection rate with transrectal.
So my post to you is I hope you don't join our group and your biopsies are negative.