@skimore
If the PSA tests comes back negative, you don’t need to take a biopsy. That’s really the purpose of having it. They will tell you whether there is prostate cancer in your body. With a Gleason six there may not be.

If you do have a biopsy, try to get a transperennial Instead of transrectal. Less chance of infection and they can get to more of the prostate that way.

You should have an MRI before you have a biopsy so they know where to look and know where to take samples, It should be a guided biopsy.