med challenge; upcoming Bx and decisions to follow....overwhelming

61 y.o with ongoing symptoms which urologists all deemed as bph. Just relocated to Fla from Mass so very different medical treatment here. Exhausted from frequent urgent urination, hematuria, unable to empty bladder and recent increasing back/skeletal pain. MRI prostate shows 3x5mm nodule in prostate but pirads 4 and its peripheral zone. I'm also BRCA 1 carrer, so higher risk - that's the ovarian/breast cancer gene that Angelina Jolie had etc.
I guess the only positive note is that the nodule is small however, but for me (some OCD tendencies) I have trouble just "waiting" so although I may have time I like to plan my options so I appreciate any knowledge you guys can share.
If I was having surgery, I'd opt for top hospital if I could, like Mass Gen in Boston, MD Anderson or John Hopkins. Florida may be ok for scans and biopsies, but the local hospital ratings are not great. Have to find a good doctor.
There's also varied opinions on if Gleason 6 needs to be watched or acted upon.....and then there's the issue of radiation vs focal ablation vs total prostatectomy. In the past I know, the side effects made a difference from the reads on various procedures. So much information and some of it even contradictory. Thank you for sharing and my thoughts and prayers to all.

Have you had a biopsy yet, or only the MRI?

I have read several posts by men whose PIRADS 4 (and even PIRADS 5) lesions were later biopsied with no cancer found. So, without a biopsy you are just guessing. Sure, all of us have panicked when we first suspected having PCa, but you won't really know what your risk (if any) is until you have a biopsy pathology report.

Urologist wasn't aware but I searched all over for MRI guided biopsy scheduled for June 15...3 hour drive. Been thru 3-4 urologists in past 10 years, and pushed for this MRI -just to rule/out and found this nodule.
My PSA that I can remember was .7 .9 1.1 1.9 1.9 1.8
they were monitoring PSA to ensure it remained stable....but we now know that PSA alone is not always an indicator. This site has good information for newcomers that I spend time reviewing as well. Thankfully I found you all. It's extra tough being alone with family back North.
I understand prostate cancer may be multi-focal ...but once the prostatectomy or treatments are done, how does it recur? Wouldn't testing to determine diagnosis indicate where possible mets? I apologize if I ask a dumb question, I'll use the "i'm new" excuse for now.

You are misguided in your thinking about hospitals - it is the doctors and their experience that counts. Probably the most experienced prostate surgeon in the world is right there in Orlando - Vipul Patel. It is true that many of the top doctors are associated with many of the top hospitals, but that isn't always the case.

At any rate, get a diagnosis first.