Active Surveillance and Chasing PSA

Active Surveillance and Rising PSA (Multiple Negative Biopsies)
I’ve been reading many threads here and have learned a lot—thank you all for sharing your experience and knowledge. I wanted to post my own situation and see if anyone has had something similar.
I’m 65 and have been followed by the same urologist since I was 57 for PSA and BPH. My BPH has been well controlled with medication, but my PSA trend continues to be the main question.
Timeline / key results
Age 57: routine annual bloodwork showed PSA 5.2 → referred to urology.
Diagnosed with BPH; started/maintained on medication (including finasteride).
2018: 4K blood test returned high risk (81%).
2018: initial biopsy (16 cores) was negative.
Over the years: PSA checked about every 6 months and DREs performed; all DREs have been negative.
On finasteride: PSA ran steadily ~2.0–2.5 for years.
Most recent PSA: 4.08 (about double the test 6 months earlier).
Took a course of antibiotics to rule out infection; repeat PSA was 3.96.
It had been just over 2 years since my last MRI/biopsy, so I underwent a “saturation” biopsy (24 cores): all negative.
In total, I’ve had four biopsies, four MRI scans, and 73 cores taken. Across all of that, there has only been one finding of low-grade cancer (in 2018).
My earlier MRIs showed a PI-RADS 3 lesion, but the most recent MRI did not note any PI-RADS lesions. (That last MRI was done at a different facility than the prior three.)
My questions
Has anyone had PSA rise like this (especially while on finasteride) despite repeated negative biopsies?
Have you seen differences in PI-RADS reporting when switching MRI facilities, including a prior PI-RADS 3 no longer being reported?
What additional questions or tests would you discuss with your urologist in a situation like mine?
I have a follow-up appointment next week to review the biopsy findings and discuss the plan going forward.
Thanks for listening, and I appreciate any thoughts.