I feel there is much confusion on this subject. I am 80 years of age with BPH. While pursuing steam treatment with my urologist for BPH he took at PSA that came in at 4.2. Now I am concerned about possible PC. He recommended biopsy but I am not comfortable with that because of risk of spread if it is cancer. We did a MRI and came back clean except for one 7mm lesion rated as "probably PC" by radiologist. Now I am taking PSA total and free test every 3 months. It indicates that the lesion is probably "not" cancer or if it is it would be low grade. So I am in "active surveillance mode. Doing another MRI soon to see if lesion has grown. At my age I being very careful with anything invasive. If it does grow perhaps a focused non invasive therapy is way to go without a physical biopsy. Assume it is PC and do it. Or do nothing if it grows slow.