Prostate cancer is usually diagnosed when elevated PSA levels lead to a TRUS biopsy. We present a case in which there were several negative biopsies and a rising PSA. This led to a multiparametric MR (mpMRI) which demonstrated a large mass which originated in the anterior transition zone and had extended through the anterior fibromuscular stroma and prostate capsule with a significant extra-prostatic component. The mass was successfully approached anteriorly with a CT-guided biopsy. The patient was subsequently successfully treated with radiotherapy utilizing MR in the planning process. This case report summarizes the utility of mpMRI in this clinical setting. For patients with high suspicion of prostate malignancy despite prior negative biopsies, it can identify tumor in locations not amenable to TRUS biopsy. It also is critical for accurate radiation treatment planning, allowing for increased confidence in tumor targeting as well as sparing sensitive normal tissue.