Regarding the MRI results - first a PIRADS 3, then a PIRADS 2 —> Always remember that PIRADS results are just one specialist’s educated and experienced opinion of what is seen in the scan. It’s recommended to get a 2nd opinion on the scan — not necessarily because you don’t trust the 1st one or don’t like that opinion. But, because much of the interpretation of images and scans is often as much an art as it is a science, and it’s dependent on the skill and experience of the person reading the slides. It’s good to have an independent set of eyes reviewing the scan (especially one where the PIRADS results change).

Yes, it could simply be due to BPH.

How are all of your other test results: Bone scan results, CT scan results, and genomic (biomarker) test results?

With your family history of prostate cancer, have you had a genetic (germline) test?

With all that additional information, you can have confidence in your next decision regarding a potential biopsy or just continued surveillance.