A few thoughts —>

You mention “a 10 year avg PSA of 1.0.”
> what is your most recent PSA?
> what is your PSA Doubling Time?
> what is your % Free PSA?
> what is your PSA Density?
Those will help provide more clarity as to where you are right now (without being so invasive).

You mention “a positive MRI in '25 with 2 - pyrad 3 and 1 - pyrad 4 tumors detected.”
> was there any mention about extracapsular extension, seminal vesicle invasion, or perineural invasion?

You mention “a negative fusion transrectal biopsy in Oct. '25.”
> by “negative,” do you mean that every core sample description indicated “benign”?

These MRIs you’re getting, are they 3T MRIs?

As for another biopsy, if it were me, I would only get another one if the MRI indicated a need. Plus, I would request a 2nd (independent) review of the previous MRI scan and tissue biopsy. Much of the interpretation of tissue biopsies (as well as images and scans) is often as much an art as it is a science, and depends on the skill and experience of the person interpreting them. Having a 2nd set of eyes reviewing them is always a good idea.

As for biomarker tests, I used OncotypeDx and Prolaris. There are so many biomarker (genomic) tests, that as with any tool the one you use depends on what you’re looking for,