In the absence of an indication for pelvic lymph node dissection or when this has already been performed by other procedures, perineal radical prostatectomy provides excellent local control of localized prostatic cancer. By respecting the local and general contraindications (volume of the prostate, suppleness of the hip joint, cardiovascular status), perineal prostatectomy ensures good quality resection strictly identical to that obtained by retropubic prostatectomy. The time to return of continence is unchanged. The only problem consists of the difficulty of preserving the neurovascular pedicles responsible for erection. Pre- and postoperative care, as well as surgical technique, are described to provide the reader with an overview of this attractive surgical technique.