Psa, mri, prostate biopsy what next to be sure

Speaking to the BPH only:
https://aquablation.com/
On PCRI.ORG has some great information videos.
One in particular on PCRI.ORG:

Ray

Your somewhat high PSA can be completely caused by BPH. Your free PSA doesn’t imply much of anything.

You could get a PSE test to see if you do have prostate cancer and the biopsy missed it. When you have a biopsy they only get about one percent of your tissue so it could be you still have prostate cancer.

Get treatment for your BPH and see if your PSA drops a lot. You do have a large prostate so as a result, you do have a higher PSA than normal. I know somebody had a really large one. His PSA was 50, but they never found anything doing biopsies..

@jeffmarc
Thank you Jeff,
I was thinking a biomarker test. This is so new to me. I have been followed for years with a psa by my pcp. I will ask my urologist about that pse test.
Thank you

@ray092271
Thank you Ray, i will watch the video.

I have been searching Aquablation for sometime, then found out I had PC Gleason 3+4 Stage 2, decipher .46, PSA 2.9, prostate 69cc, My urologist is also great with Aquablation, but said its not quit there for PC. Then I found this, video and thought I would further check it out by reaching out to Dr. Helfand Md.

@ray092271
Thank you I did see Dr.Helfand video on the aquablation.

What was your prior PSA test? With PCa it tends to go up by a significant percentage. A PIRADs of 3 can go either way (mine was benign). Even if PCa very good chance it will be 3+3 Gleason and recommended active surveillance. I agree that the next steps should be getting PSE and seeing you what treatment is available for BPH. If you cannot get the PSE make sure you follow up with another PSA test in 3-6 months (useful even with PSE). If PSA is still rising (like a 7+) then a biopsy is warranted. PCa tends to be slow growing.

I agree with Jim and Jeff. Get the PSE test. It will tell you, with 94% accuracy, whether you are likely, or unlikely to have prostate cancer. Here is a link to the product page for Oxford Biodynamics, who make the test.:
https://www.94percent.com/

In addition to the EpiSwitch (PSE) test consider another look at the MRI:
Analogue:
http://mayocl.in/1mtmR63, Johns Hopkins too
Digital: AI, 'MaleScan' precisionprostateconsulting.com $259.00 if insurance denies, no fee if the data sent from the facility cannot be processed, currently disks are not usable

A second read of the MRI may add another path too:
ANALOGUE:
1) NIH 2nd Opinion MRI (no fees): Choyke, Peter (NIH/NCI) Radiologist pchoyke@mail.nih.govhgc ATGfo3zx)
2) Hopkins Images and Reports for Providers | Johns Hopkins Radiology (hopkinsmedicine.org) Email: eradiologycenter@jhmi.edu Phone: 443-287-7378
3) Mayo clinic http://mayocl.in/1mtmR63
DIGITAL:
AI comparison with thousands of MRIs 'MaleScan' precisionprostateconsulting.com If facility data sent is unusable there is no fee ($259.00) to insurer or if denied to you. Disks not usable currently.