@ireland1964 That is one way to look at it. The other way to look at it is that 75% of the time the biopsy match is either the same or better; only 25% of the time is it worse. (All depends on whether you’re a “glass half empty” or a “glass half full” type of person.)

Prior to biopsy (these should always be checked, even before MRI):
> PSE test (it’s 94% more accurate than a PSA test)
> % Free PSA
> PSA Doubling Time (or Velocity)
> whether the PSA increase is due to a UTI, prostatitis, or some other non-cancerous reason.

After MRI (prior to biopsy):
> PSA Density
> whether the PSA increase is due to BPH or an enlarged prostate

Prior to a tissue biopsy, there are many liquid biomarker tests to choose from, depending on what exactly you’re looking for:
> (from blood): 4KScore; Prostate Health Index (PHI);
> (from urine): SelectMDx; PCa3 (PC Antigen 3); MyProstateScore (MPS), ExoDx.

A urologist can use one or more of these test findings that are available before doing a tissue biopsy to get a better idea of the true nature of the disease.

Ultimately, a tissue biopsy is considered definitive.

After tissue biopsy:
> Prolaris; OncotypeDx
> genetic (germline) test

(I’ve probably missed others.)