Hello 'retireddoc',
I have a touchy question that has bugged me for a goodly while. And I mean no disrespect nor to contradict or criticize your reply; in fact it was fantastic.
But I like many sought a doctor/urologist who had lots of experience as well as many RARP's of experience. All good.
But how do doctors of any specialty or field get those first 10 or 100 procedures if patients like me seek only those with more experience??
Is there a protocol for that??
Again, no offense meant and I hope none taken. Thank you!

Thanks so much for the detailed information, I am also 70 my PSA had started up a cpuple years ago 2.27 to 4.47 back to 3.73 then a couple months ago to 6.24 I finally got in to see a Urologist December 13, I had a Parametric MRI on a 3T on 12/26/23 it showed 1 lesion 12mm and my PIRADS was 4, my Urologist also ordered a 4K score blood test, on a scale of 1-95 (under 7.5 not aggressive) mine was 95 the most aggressive, I am waiting to get scheduled for a needle biopsy then a Gleason score. The MRI did not show anything in the pelvic bone ( although I have developed bad tailbone pain in the last 6 months, I attributed it to my long distance motorcycle rides) nothing in bladder or pelvic lymph nodes.
I have to be realistic that I have some kind of Prostate Cancer. My prostate was enlarged 44.1 CC and I have had BPH symptoms for at least 2-3 years I understand the best needle biopsy is guided by an MRI vs a rectal sonogram (TRUS?) again thanks for sharing your details, my Dad had PC and radical prostatectomy in 1984 at age 64, he thought the s surgery ( perineal) let out some cancer cells, he must have had a slow growing kind as he was treated with different drugs at Mayo Clinic and lived to be 90 when he died after the PC went to the bone
I have lots of cancer in my family so this was not a shock to me

Dear retireddoc, thankyou very much for post that is very interesting for me.
In my father's family (6 male brothers) everyone underwent prostate surgery (BPH) at a relatively young age (around 60 years old). Four of them died from various cancers but not prostate cancer; although it must be said that they all died between the ages of 69 and 73.
I started with classic BPH symptoms at 38 and had to have surgery (TURP) at 51. Since then I have always had an annual visit to the urologist and a PSA test every 6 months. I am now 66 years old. The PSA went from 1.6 (January 15) to 3.98 (January 24). No suspicious abnormalities were detected on rectal touch. My urologist, suspicious of this gradual and constant increase in PSA, orders me a multiparametric MRI in 2015, then again in 2021. Both results were negative, without suspicion and without alterations, PIRAD 2.
Despite this result, the urologist recommended performing a biopsy. Since it is a very invasive and sometimes very painful exam, I preferred not to do it and repeat the MRI the following year (2022) with identical results to the previous ones. Today my PSA is 3.98 and given its linear and constant increase I think I can already predict what it will be in one or 2 years...
I have consulted several doctors, radiologists and urologists and the opinions are divergent. There are those who think that in the presence of 3 P-RADS 2 MRI and without variations over the years, it is not justifiable to perform a biopsy just because the PSA increases; this increase would be justified by age. There are those (almost all urologists) who recommend performing a biopsy anyway.
If I understand correctly, it seems to me that your case demonstrates that the increase in PSA can indicate the presence of PC, even if the various MRI scans are negative.
Considering your personal experience, as a patient and radiologist, I will really appreciate your feedback

Thank you so much for taking the time to provide your input/experience. Going back through all the replies again. I had met with the surgeon in my health network a few weeks back and just met with the Radiology Oncologist yesterday (4/25/2024). Apparently it took so long because they sent the referral to the wrong provider?
The Radiology Oncologist was a lot more helpful than the surgeon that would be performing the RP. Just a lot more info about the different treatments. Spent a lot more time with me. His main message was that (as many here have said) both forms of treatment are effective and that it's really about what makes the most sense for me.
He said PSA 8.6, Gleason 7, Stage 2 are the numbers I need to focus on. And the fact that more than 50% of my biopsy samples showed cancer (3+3, 3+4).
Those are the things that dictate his course of action/treatment recommendations. He said that because I am kind of "in the middle" as far as age, radiation OR surgery are both good options.
I was leaning toward RP before I met with him but now I'm not so sure. His area of expertise EBRT and that is the treatment I would get if I opt for radiation treatment with my current provider.
He said incontinence/impotence likelihood for surgery is also higher than radiation (50% to 33% respectively)?
He said he, in my position, would not have a problem having the surgeon in my network perform the surgery if I chose that.
He said there can be benefits to going to a Center of Excellence for treatment but in many/most cases, the added travel, cost, and trouble just don't justify it unless you live somewhere where treatment quality/cost, or the experience level of your docs/surgeons (or lack thereof) warrants it.
He said the peace of mind of getting the best care available to you regardless of cost may be the biggest benefit and not trivial if it brings you peace and gives you confidence to move forward.
So more info to digest from yesterday to help with my decision.
Hoping others will chime in based on this latest info.

Thanks all.