Twelve patients with adenocarcinoma of the prostate underwent radical transcoccygeal prostatectomy. The methodology and outcome are described. Preoperative laparoscopic lymphadenectomy was performed on all patients. The average operative time for the prostatectomy using the transcoccygeal route was 3 h and 7 min, and no major postoperative complications occurred. Compared to the classic retropubic approach, preservation of the neurovascular bundles and urethral anastomosis seemed to be facilitated. It was concluded that radical prostatectomy can be performed safely using the transcoccygeal approach.