Hi @fredz Two caveats before comments, I'm not a doctor and everyone has to do what they are comfortable with...

"hate to do biopsy"
Well, that's certainly understandable, they aren't fun. Having said that though, I think it's probably time you did something. If you aren't sure there isn't something else going on, maybe go get a second opinion, but, I wouldn't just wait it out at this point without knowing what's going on.

Having been, sort of, where you are. I had symptoms, but those symptoms are the same as BPH for the most part, I could have rationalized that it was that and not had the biopsy. However, now it's playing on your mind (ask me how I know). There's certainly a part of me that said, if "I don't get this checked I can't get the bad news" but for he most part, I wanted to know if it was time to engage and start the fight.

Using the reverse logic, If in the back of your mind, you think it might not be cancer, why not confirm it and calm your mind?

A PSA climb like that is generally indicative of a problem + finding the lesions. It may be that you don't have symptoms because of where the lesions are (not impinging on the urethra perhaps). It's true that this is often a slow moving cancer but I wouldn't give it too much space. I scheduled my biopsy at a PSA of 11.

When I first went in because of the rising PSA my doc did a digital rectal exam and appeared somewhat flummoxed, it felt entirely normal. We talked about 5 minutes and I asked for the biopsy. Turns out the cancer was all inside the capsule of the prostate and that's why he couldn't feel it. The PSA went to 13+ by the time I had the RP.

I'm still not sure if the doctor was really vacillating on the biopsy recommendation or he was waiting for me to ask for it for "buy in" purposes. I like to think he'd have only given me a few more minutes before pushing me towards it.

The only other factors I can think of would be age and general health condition that might play into this decision, I was only 59 and generally in good health so these were the best decisions for me. Everyone is different.
Best of luck to you!