I am posting this for a friend in India.
He has had several biopsies (last two MRI guided). All negative. For his last biopsy he even travelled to one of the best urologists in Europe (paid out of his own pocket).
All other signals (PSA, PHI,..) look concerning. At this point, he is so fed up that he will take treatment and get done with it.
Thoughts?
If he has had negative biopsies, why would he get treated for a disease he doesn't have? I think that's a symptom of a mental disease - he should see a psychotherapist, if you can convince him.
Several biopsies, all negative. Two MRI's...any idea what his PIRADS scores are? Based on the little you report, your friend should join our community instantly and listen to what his peers might have to say about his condition. What did this "exemplary" european urologist say? What doctor will treat a man with multiple negative biopsies? (please share the name so we can lambast and avoid).
That you're here is ok, but he needs to post and read for himself. As per Tall_Allen, Psychotherapy is a helpful suggestion too. I rarely offer my opinion in our communties. Your friend's case illustrates an opportunity to reap the extrodinary value of peer to peer prostate cancer discusion...but, he must show up here to benefit.
What are the other indicators? What is his PSA ?PSA velocity? Doubling time?
Even with PCa it may not need immediate action (and side effects). Active surallience may be an option (I was able to do it for 11 years).
I agree with the above. Slow down, educate. There are side effects to treatment that need to be understood. There are options.
Message relayed to my friend. I told him how wonderful the community is.
My husband unintentionally did AS for 11 years, 2003-2014. With a slowly raising, sometimes declining, PSA, biopsies were negative every single year including 3 months prior to his simple prostatectomy for BPH (prostate 125+ cc). The extremely well-known robotic surgeon did not see any reason to do an MRI-guided at a PSA of 14. Tumor was found in post surgical pathology.
Very interesting. Did he do further treatment?
Yes. The very celebrated robotic surgeon was convinced he'd "gotten it all," but of course hadn't. He convinced my husband that he need a salvage surgery. Salvage surgery pathology was completely negative. It took Pylarify (last man of phase II clinical trial at Stanford) to locate the recurrence in the prostate bed at the end of 2018. He then did 2.5 years of bicalutamide and 39 RT. Bical was finished a year ago October of 2021. He's still on 3-month labs, one coming up next week. Fingers crossed. Gleason was 3+3 at diagnosis, upgraded to 3+4 (one of four cores) after MRI guided biopsy before the worthless salvage surgery, then upgraded to 4+3 (the MRI guided biopsied tissue, not the original pathology after the simple prostatectomy) by Mayo RST.
Don’t biopsies often miss existing cancer?
groundhogy wrote -- " Don’t biopsies often miss existing cancer? "
Over 90% internal volume coverage of the prostate can be obtained by means of the Saturation Transperineal 3 Dimension Prostate MAPPING Biopsy.
True. But he has had 5 biopsies (last two MRI guided). Maybe it is just his enlarged prostate. His prostate is pretty large.
If he won't see a psychotherapist then tell him to get it ripped out by a highly rated Urologists.
I think he is nervous I think because of family history of PCa. I advised him to get a genetic test as well. 
Not All Prostate Biopsies Are Alike!
Advice on new treatments . 
Side effect of Lupron
Another one has left this earth
