@ezupcic Find a urologist that does fusion guided Transperineal biopsy. Even it means traveling a few hours. This type of biopsy is becoming more common so shouldn't be hard to find a urologist that does them. Teaching hospitals usually do them as well. This is a big important part of the puzzle. And after that a PSMA will be the final piece of puzzle to help decide on treatment. Of course there are genetic tests that can be added to see if adding ADT, or how you will do with SBRT, etc. But the main parts of the treatment puzzle are the MRI, Biopsy & PSMA. I know you mentioned SBRT which might be a good option with perhaps a brachytherapy boost and maybe ADT? Best of luck