During the past 15 years radical retropubic prostatectomy (RRP) has become the treatment of choice for localized prostate cancer. Before the 1980s the procedure was characterized by a significant number of intraoperative, postoperative and long-term complications. Since then the operation has evolved continuously, using the results from anatomical studies, and has resulted in a marked reduction in the morbidity and mortality associated with this procedure. The modern, anatomical approach to RRP emphasizes the principles of direct visualization and identification of the anatomical structures in the pelvis. Management of the dorsal vein complex and techniques for apical resection of the prostate, combined with improved understanding of the pelvic floor anatomy, have contributed to a reduced frequency of postoperative incontinence. The identification and localization of the "erectile nerves' (autonomic branches of the pelvic plexus to the corpora cavernosa) in the neurovascular bundles outside the prostatic capsule and Denonvilliers' fascia enables nerve-sparing surgery. In selected cases, sparing of the neurovascular bundles is possible to preserve sexual function without compromising cancer control as the principal goal of RRP.