@thig350 Going straight to biopsy is what’s referred to as a “blind biopsy” because it’s just taking blind stabs into the prostate with hopes of hitting something of interest.

Doing an MRI first allows for identification of suspicious areas (and assigning them a PIRADS score - from 1 to 5 - indicating the likelihood of significant cancer being present), and then (if a PIRADS 3, 4, or 5 is identified) doing an MRI-guided fusion biopsy of those suspicious areas (plus a few random areas adjacent to those suspicious areas).

Yes, what your urologist wants to do can be done, but it’s very old-school - the way it was often done in 2012 when I was initially diagnosed with prostate cancer.

Actually, the “strength” of doing an MRI first is that it does not rule out cancer - because its purpose is only to identify possible suspicious areas in as least invasive a way as possible. You want to hold off invasive procedures until necessary.

If you research the modern standard of care for diagnosing prostate cancer, it involves the sequence: elevated PSA —> (sometimes a DRE) —> mpMRI —> MRI-targeted fusion biopsy.

Of course, discuss all this with your urologist.