ObjectiveTo define the principles of management for men with localized prostate cancer and concomitant bladder or colorectal lesions that require operative intervention.MethodsReview of three patients treated with simultaneous radical retropubic prostatectomy and bladder diverticulectomy or colonic resection.ResultsRadical prostatectomy and concomitant procedures were safely accomplished in all patients with no significant operative morbidity and good functional outcomes. Both operative time and length of hospital stay were prolonged compared to radical prostatectomy performed alone. Measures to prevent fistulization between urinary and colonic suture line contributed to the success of these procedures.ConclusionsThis approach should be considered for management of localized prostate cancer and other pelvic lesions in selected patients.