Correct me if I am wrong in my thinking here but it seems logical that someone whose PCA was LESS obvious and had a less likelihood of even having PCA would benefit much more greatly from an in-bore than someone like me with an MRI PI-RADS 4.
What you want above all is for the biopsy to sample the highest grade of tumor that is present. That is what an expert in-bore biopsy achieves that typical biopsies may not. The fact that you have high grade tumor is not the same as saying that there is a lot of it to be found.
I went through this in 2017 when my first ever PSA test came back highly elevated.
I researched in-bore MRI prostate biopsy for the same reason as you. If it was available and affordable, why not get the best.
I learned the following:
1. Requires 3-tesla MRI machine and multi-parametric technique.
2. Requires highly experienced practitioner to accurately read the MRI output. Many practitioners do not qualify.
3. Both of the preceding are expensive.
4. For those reasons, true in-bore biopsies are performed at a very small number of "centers of excellence" nationwide, something you have verified with your search efforts.
The value of getting the best is two-fold. In addition to the likelihood of sampling the highest grade of tumor, if the practitioner is truly expert, a negative finding upon MRI analysis can be the basis of avoiding a biopsy that is not yet indicated. As already discussed, there are several reasons for PSA to suddenly jump.
Note the following:
When the true in-bore biopsy is performed, the practitioner is not referring to the previously obtained MRI images, because things move around some. He has studied the images to know the overall situation, but he is relying on the same expertise he used to assess the output of the first MRI to identify the target(s) in the real-time in-bore view. A proper in-bore biopsy is performed by the same practitioner who did the assessment of the first MRI output. Or, alternatively, a second practitioner of equal or greater expertise, will ignore the first report, and use the output of the original MRI to do his own assessment, and biopsy if indicated.