Metabolic syndrome (MetS) has been linked with several human cancers. Prostate cancer is the most common neoplasm in male adults and is often treated with radical prostatectomy (RP). Given the complex hormonal and metabolic alteration present in MetS, a possible role in the development and progression of prostate cancer (PCa) has been hypothesized. Several studies have investigated the connections between MetS and the risk of developing prostate cancer, as well as the oncological outcomes of patients who already suffer from PCa and receive a radical treatment. This comprehensive review explores the available evidence dealing with MetS and the oncological and functional results of RP for PCa.