Gentlemen: These are truly your choices and I respect them.
I had no problems with my transrectal biopsy.
My PSA was 3.9 in 2018 at age 68; 4.6 in 2020 at age 70 (some literature said age 70 normal PSA was less than 6); 5.9 in 2021 (retaken 3mos later 5.7).
Reluctantly (because I did not want to overreact) saw a Urologist in Dec 2021, who scheduled MRI for April 2022 and follow up for June 2022. No apparent urgency.
MRI identified PRads 4 & 3.
Fusion guided 18 core biopsy July 2022 found Gleason 8s and one 9.
Surgery August 2022. All clear postop, BUT extraprostatic extension (EPE) found outside prostate capsule, but within surgical boundaries.
Failed 1st postop PSA @ .19 ( repeated 30 days @ .18).
Now 1 year later, I have completed 2 mos of IMRT to the pelvic floor and pelvic lymph nodes, within a 4 mos course of ADT, and just received 1st post tx PSA < .02 (undetectable).
And I am very grateful for that uPSA result and all of my diagnoses and care.
However, I have some remorse about whether or not I could have, or should have, acted sooner vs not wanting to get caught in the Gerbil wheel of worrisome inconclusive diagnostic tests.
So, I get it and am only sharing my actual experience.
And I am not sure that I have ever seen a definitive medical statement that Gleason 3 + 3 never evolves to higher, more aggressive Gleason scores.
I only wish you and all the best, and that you never have to experience any progression or concern.
From my 2 yr journey, the only thing that is clear to me, is that nothing about this insidious disease is clear.