I too had a diligent urologist who had been keeping an eye on my PSA and when things started changing, he did several biopsies over a year period until they found definitive signs of cancer at age 49. I was offered various radiation treatments as being "less invasive", but when I found out that they all caused so much scaring that it made any kind of follow-up surgery impossible if the cancer came back, I opted for a radical prostatectomy.
Unfortunately, I can verify that as being true. I went to one of the best surgeons at University of Michigan, but still wound up with permanent ED. They started the robotic surgery about 6 months after I had the conventional one. I tried some of the ED "treatments" they offered me, but they all had bad enough side effects that sex was about the last thing I wanted. They ran the gamut from the little blue pills that gave me raging 3 day migraines, to the self administered injections where you never want to be poked with a needle. When they told me that they could implant a tiny manual pump in my scrotum that could be pressed repeatedly to pump it up, I said no thanks and left it at that. Yeah, I could just picture it. "Not yet honey, I'm still trying to pump it up!"
Probably because the insurance companies have some actuarial tables that tell them that it works out to be cheaper for them to pay for treating the cases of cancer that do occur, than it would be to pay for all that additional testing. Yeah, I'm cynical. Lack of sex can do that to you.