Biopsy is not without risk. There is a specific risk of developing prostatitis due to getting the biopsy. The question is whether there is sufficient evidence to get the biopsy. My feeling is that if the urinary symptoms change, that would tip the balance in favor of biopsy. I should note that my father's symptoms started with nocturia, which drove him bananas. The cystoscopy is a horrific procedure that sounds like it's straight out of the Middle Ages, but my father manned up and did it because the symptoms were driving him nuts. I know this is all likely in my future because it's not skipping generations with the males in my family once they get north of 75.