Radical prostatectomy remains the treatment of choice for clinically organ-confined prostate cancer. Radical perineal prostatectomy (RPP) offers some distinct advantages over the retropubic approach and constitutes an attractive option for treating prostate cancer in many patients. These features make RPP an attractive treatment choice for patients with clinically organ-confined prostate cancer. It has long-term efficacy in treating clinically organ-confined disease. RPP has the distinct advantage of allowing prostatic dissection in a relatively avascular surgical field, providing good exposure for reconstruction of the urethrovesical anastomosis, and allowing dependent postoperative drainage of the prostatic fossa. Modifications of the classic RPP include the nerve-sparing approach to preserve potency as well as the wide-field dissection RPP for suspected locally advanced disease. The key advantages include long-term disease control, low morbidity, and fast patient recovery. These features translate into direct and indirect cost savings, factors that may gain increasing importance in the future. It appears likely that the resurgence of the perineal approach will continue, making it important for contemporary urologists to familiarize themselves with this procedure.