considered. I would definitely see a urologist and get a "free and total" PSA test. IF you eventually elect to have a biopsy, know that while they are not fun, they are not really painful. And, don't hesitate to get second opinion before doing anything you aren't totally sure about.
Good luck. Statistically, results will be ok. Much reliable info available on web. I rec Mayo Clinic site and WebMd.

And there are treatments for BPH so that's something to inquire about as well.

If surgery is recommended get a younger surgeon. And ask him if he played lots of video games when he was a kid. Sounds funny, but the skills to do that apparently transfer to robotic surgery.

The enlarged prostate has never been an issue for me, so that's why I never asked for any treatment for it.

a facility such as UCSf, UCLA, or others throughout the country who specialize in a prostate MRI, and if suspicious areas are found in the MRI consider a directed biopsy on those suspicious areas

Blind biopsies are a needle in a haystack proposition

Yes, my doc mentioned the biopsy, which I was a bit squeamish about, but now I'm glad to do it.

They wanted to be sure it hadn't spread.

And being near a major medical hub is important. Best doctors, best gear, up to date techniques.

Depending on all of your factors, he/she may or may not do a biopsy. My friend had prostate cancer and ended up getting it removed, but he said the initial biopsy itself was not too bad. They took several samples, and he described it as feeling like "rubber bands snapping", but was not horribly painful.

Your favorable PSA test and ultrasound are certainly good signs, but as said above, there may be other factors that are to be used to assess your risk.

My opinion is that it is always better to be on the safe side with things like this. It is possible and maybe probable that everything is fine, but I would investigate further, if only to ease your mind.

I go once a year to the urologist, and their exams are more thorough than a regular doc.

Good luck.

being neither sensitive nor specific enough to be a good predictor of cancer.

Your evaluation so far has been right on the money, from a clinical perspective. Get an evaluation from the urologist you were referred to. One of my biggest frustrations in clinical medicine is diagnosing a patient and referring them appropriately, only to have the patient drop the ball on follow-up.

With prostate enlargement, there's not generally too much to worry about. Even with a nodule on your prostate, the odds of it being highly-aggressive cancer are fairly low. Even if it is cancer, most likely it will be a slow-growing variety. So slow-growing, in fact, that conventional wisdom nowadays is to leave it alone because you're much more likely to die of something else.

There was a time when a diagnosis of prostate cancer automatically meant a prostatectomy. This led to all kinds of quality-of-life issues, including incontinence and impotence. Now, they only do a prostatectomy on the more aggressive forms of cancer, otherwise leaving the gland, and your quality-of-life, intact.

I was heartened when he gave me the option of seeing the urologist. If he had been more insistent, that would have worried me a tad. I'll do everything the urologist recommends, and hopefully everything will be ok.