Opinion Wanted - Biopsy or Not

I'm 61. My PSA, MRI and biopsy history is in sig.

To summarize, DRE and ultrasounds are always good. No family history on either side for PCa.

MRI last week was clean but did show further enlargement (from 39 to 55). My PSA, as you can see, is high but no major, sudden jumps and always in that 5-7.9 range over the last several years. 2 older biopsies were clean as was the MRI in 2018 after the PSA increased (with the first enlargement as well).

The only uneasiness concerning just continued testing for PSA is that my last PSA test was a 4K version. My score was 20 which is a red flag and prompted the MRI. Since that was clean (but did who more enlargement), the thought is to check PSA in another 6 months and go from there.

What are the collective thoughts? Is the 4K test on it's own something to take action on when all other indicators are good? I really don't want another biopsy if I don't need one.

Thanks

What’s been the trend on your PSA density?

I agree with Pratoman. If you do, you may as well have more than 12 cores done, even if less that a saturation biopsy.

Djin