Again, thank you all for your thoughtful responses!!
@jim18 and @jeffmarc , your responses last night were very helpful. Jeff, I am 70.

First, I should try an antibiotic to address possible inflammation (as probably in 2025 and certainly in 2022).

I also was not paying attention to % free PSA before, and am now. 3/2026 test was (Free PSA 1.15, % free PSA 13.9%) vs 3/2025 (Free PSA 1.12, % free PSA 19.3) so I am moving in the wrong direction since higher is better for % free PSA

I was not aware of the PSE test before yesterday, and it does seem a better test than ExoDx.

So I think I will engage with my urologist to suggest that they order antibiotics, and then a PSA retest including free, %free PSA, a PSE, and perhaps a 2nd MRI, as prudent first steps before a biopsy. Biopsy seems appropriate and I am ok with doing it based on the comments in this forum, but these seem like appropriate first steps to inform any subsequent action like biopsy..

Thank you!!!