Psa is 4.5 pca3 70 mri shows nodule with moderate chance of being cancerous?

See comment: Your psa is not high for your age was the MRI done on the prostate ? If you are satisfied with your urologist, let him pursue your case and help you.

See answer: On the basis of those results, there is a high likelihood (>50%) chance of finding prostate cancer on prostate biopsy. Without knowing more specifics, and depending on the age and health of the pt, a prostate biopsy (the most definitive diagnostic test) would usually be recommended next, the pros and cons of which should be discussed with a urologist to reach a mutual understanding and agreement.