All good comments above! Yes, you need the biopsy. I am scheduled for my second one in a month and, if it's similar to the first, it's no big deal. My urologist did the MRI-guided transperineal with only lidocaine (if anything). It took him about 15 minutes to take about 2 dozen "snips" from various areas of my (large) prostate. Someone on this forum compared the sample-taking as like the sound and feeling of a staple gun. I agree. Minimal aftereffects as described in other posts above. Good luck.