New to group, Pre biopsy testing

Your PSA of 15 then 8 and the MRI result that found a PIRADS lesion both indicate that a biopsy is needed. So yes a biopsy is the logical next step. One other test is a PSE that is just a blood test. It's more accurate than a standard PSA. If your Urologist doesn't offer it, insist on getting one done.

It would seem your ExoDx and your ISOPSA also exceed their threshold numbers so that combined with your PSA and identified PIRADS 3 lesion definitely call for a biopsy. I don’t know trying to add any additional diagnostic tests change any of that. With a identified PIRADS lesion they will probably want to do an MRI fusion guided biopsy to get multiple bites from the lesion then there random grid across the rest of the prostate.

It has been 8 months since the last PSA. If that is not a typo (15 vs 5) what your PSA is and how fast it is rising is unknown. It can go from 15 to 5 if prostate was infected at time of the 15 or it could have been a lab error on either test. Get another PSA to confirm number and rate of increase. With the ExoDx and ISOPSA well into probable cancer likely there is at least low grade (3+3 or 3+4) prostate cancer. Skip the PSE ($1000) and go to a fusion biopsy to make sure the PIRAD3 is sampled. A PIRAD3 is not cancer most of the time but more likely with 2 tests indicating cancer.

Welcome and sorry you had to find your way here. If the numbers you posted were mine, I would want a biopsy. There is no other way to know if its cancer without one. Best wishes!

If possible, there is value in having your biopsy (and if necessary another MRI) at a center of excellence or qualified Cancer Center.

These facilities will (usually) be better at MRI’s and fusion biopsies.

You do not have to rush the biopsy, based on your MRI. Taking extra time to find a location where you may want to ultimately receive treatment, would be better (most of the time).

Best wishes

Make sure to get a Transperineal fusion guided biopsy. More accurate and less chance of infection if Transrectal is done. Best of luck

I know transpernial biopsies have some advantages.

However, 1 week ago I had a transrectal biopsy. This was due to Urologist indicating transrectal was more straighforward to complete. The attached video expresses some of this information.

September 2025, I had a transperineal fusion biopsy at a local hospital by local general Urologist. 5 positive cores all gleason 3+3. Only one of (3) targeted cores hit the lesion. The (1) positive-targeted core barely hit lesion. A Random-core had over 90% 3+3. This is a larger 1.5 to 2cm Pirads5 lesion, Doctor was trying to hit.

Last Friday April 2026, repeat Fusion Biopsy. This time it was a transrectal biopsy. This was completed at City of Hope. Surgeon recommended the transrectal. He called me tgis week, indicated 4 of the 5 positive cores were 3+4. The biopsy was repeated because the MRI and PSMA PET indicated lesion likely contained some grade 4.

I do not think the lesion progressed from 3+3 to 3+4 in the past 6 months. I think the 1st biopsy missed sampling the 3+4.

I am not pro transperineal or transrectal. My experience is the transrectal at a good facility with a good Doctor has limited risks of infection. It may have benefits in sampling some lesions/prostates.

The transrectal was very easy. Both biopsies were completed under anastgesia. No pain during procedure. Transperineal caused a little more bleeding and some blood in urine. Transrectal was almost no bleeding and I did not even have blood in urine.

@wheel1 I tend to agree. When 4 of 4 tests indicate there is a need for more invasive testing, why do a 5th?
Yes, the trans-perineal biopsy is next and is scheduled. We'll se what new info that produces.

@jim18 Yes the PSA result at the 15 level was when the prostate was angry, the second PSA (5) was taken 4mths later after courses of antibiotics. The MRI and other tests were performed because I still complained of feeling like I'm constantly sitting on a baseball, not a comfortable feeling.
As I replied to one of the other folks here, trans-perineal biopsy scheduled two weeks ish from now. Just plodding through the data collection, till there is something actionable.

Well its been a little more than a month since my biopsy has been completed. The biopsy I had chosen was a transperineal. I had the procedure done on a Thursday and took Friday and the weekend off, back to work on Monday.
The results :

Pathology reviewed today:
result
Gleason Grade: 3+4=7
POS:1
Total Cores:13
Prostate Biopsy 5/7/26
DIAGNOSIS:
A. Right Posterior Medial #1 Needle biopsy
Benign prostatic tissue.
B. Right Posterior Medial #2 Needle biopsy
Benign prostatic tissue.
C. Right Posterior Lateral #1 Needle biopsy
Benign prostatic tissue.
D. Right Posterior Lateral #2 Needle biopsy
Benign prostatic tissue.
E. Right Anterior Lateral Needle biopsy
Benign prostatic tissue.
F. Right Anterior Medial Needle biopsy
Benign prostatic tissue.
G. Left Posterior Medial #1 Needle biopsy
Benign prostatic tissue.
H. Left Posterior Medial #2 Needle biopsy
ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7 involving 20 % of the specimen (1 of 1 core(s) positive).
Gleason 4 comprises 20 percent of the cancer. Grade Group 2. Ends not involved by the tumor.
I. Left Posterior Lateral #1 Needle biopsy
Benign prostatic tissue.
J. Left Posterior Lateral #2 Needle biopsy
Benign prostatic tissue.
K. Left Anterior Lateral Needle biopsy
Benign prostatic tissue.
L. Left Anterior Medial Needle biopsy
Benign prostatic tissue. Moderate granulomatous inflammation.
M. ROI, Left Mid Transitional Zone Needle biopsy
Benign prostatic tissue. Mild granulomatous inflammation.

So of it all only one core came back indicating an adenocarcinoma, with a Gleason score of 3+4=7.
Discussion with the Surgeon as the follow-up visit he described it as "Favorable intermediate risk".
He was very quick to recommend an RP and be done with it. I declined, it is after all only one core. There has to be a better way.
My mind is currently caught up in the matrix of active surveillance, open and robotic radical prostatectomy, EBRT, brachytherapy, proton therapy, and cryotherapy. If you do certain courses of treatment you may remove other courses of future treatment as options and on and on and on... So at this moment I'm not in a hurry to make a decision, however my nature doesn't allow me to kick cans down the road for very long.
Is there (besides here) anyplace to have an informed conversation with a medical professional to truely discuss all the options and not just the ones that apply to their field?

Thanks and Happy Fathers day!