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OBJECTIVE: A non randomized prospective study aimed at verifying the clinical outcome and pathological features of a group of patients submitted to transcoccygeal radical prostatectomy. METHODS: Radical transcoccygeal prostatectomy was carried out at our institution in 26 patients after laparoscopic (24 cases) or open surgical (2 cases) pelvic lymphadenectomy. Eighteen patients were selected if considered at risk for nodal metastases on the basis of preoperative staging (PSA > or = 20 ng/ml and/or Gleason score > 5), while the remaining 8 were affected by incidental prostate carcinoma. RESULTS: Intraoperative complications included rectal injury and massive blood los in one case (3.8%). Transitory leakage at the site of the urethrovesical anastomosis and urethrorectal fistula occurred postoperatively in two patients. The rate of positive surgical margins was 26.9%. The mean follow-up time was 27 months (range 3-39 months). Total urinary continence was obtained in 21 cases (80.8%), while 5 patients (19.2%) still require urinary pads. Four patients (15.4%) have experienced tumour recurrence evidenced only by elevated serum PSA levels. Local tumour recurrence with positive biopsy of urethrovesical junction was diagnosed in 3 patients (11.5%), while systemic tumour recurrence occurred in one case (3.8%). CONCLUSIONS: Radical transcoccygeal prostatectomy is a safe procedure for the surgical treatment of prostate cancer both from a clinical and pathological point of view. Operative complications, as well as pathological features and clinical outcome reported in this series of patients, must be related to selection criteria use in the majority of cases. The exact role of radical transcoccygeal prostatectomy in the clinical setting has yet to be defined. According to these preliminary results, radical transcoccygeal prostatectomy should be further investigated in the treatment of incidental carcinoma following TURP or suprapubic prostatectomy.