I do not understand why he would be casual. It almost sounds like your dr. lacks experience with PCa. Are you in a small town in the middle of nowhere? You are 57 with a PSA of 13.8 and your other symptoms and he "didn't want to do anything right now". This is insane. What does he want to do? Wait until it progresses? !!!! What does urinalysis have to do with anything? (really, that is an honest question.)
Rather than blab on and on, like I tend to do, I'll cut to the chase. Get a second opinion. And get a new urologist. Just my .02.