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Lymph node assessment in prostate cancer is most commonly performed at the time of radical prostatectomy. We present the case of pre-operative pelvic lymph node sampling with the use of MRI/TRUS fusion-guided biopsy at the time of prostate biopsy. Lymph node pathology revealed metastatic, poorly differentiated prostate cancer, concurrent with Gleason 4 + 5 disease showing perineural invasion. The use of MRI fusion guided biopsy for nodal sampling may be an effective method pre-operative staging and treatment planning for prostate adenocarcinoma. Keywords: MRI/TRUS fusion-guided biopsy, Lymph node biopsy, Prostate cancer, Pre-operative staging