Yea my whole question is why they felt the need for any of this if PSA was steady at 1.8, digital normal, no other symptoms on a 68 yr old man
Do you know for sure he had no symptoms? They wouldn't do a mpMRI on someone with no signs or symptoms. I hope the PIRADS 4 lesion(s) turn out to be nothing.
You should read the above paper on low-PSA PCa.. The plot of PSA vs. significant PCa is U-shaped, unfortunately, with serious, sometimes metastatic, cancer accounting for the low-PSA arm of the "U"..