The communication about not testing had a negative effect on me. I had a high-ish PSA in my late 40s and a negative biopsy in 2007. Between the negative biopsy and all the talk about how PCa was over-treated, I figured I had a "get out of jail free" card. I actually continued to get tests as part of my annual physical, but I ignored the results (as did my doctor), even though my PSA kept increasing. It was only five years later that I reluctantly had a second biopsy--that one hit gold.
I do think that over-treatment can be a problem. A lot of low-risk guys don't seem to know AS is an option. But that's a different issue than testing.
Both a biopsy and an MRI can miss existing PCa. Uro's know that when PCa is strongly suspected, repeat biopsies, or targeted + systematic biopsies are indicated. Even if you assume PCa is missed one-third of the time, this rate drops dramatically
as you do repeat biopsies (do the math and you will see for yourself). As I mentioned above, non-uros are often too cavalier about
the chance that a high and rising PSA is from high-grade disease.
Hopefully we'll have excellent liquid biopsies in the not distant future, but until then I suggest you assume your uro has your health and not his vacation fund in mind when he advises a/another biopsy is in order