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The incidence of locally advanced prostate cancer has decreased in the last few decades since the introduction of screening programmes. Despite earlier detection and treatment, there is still a proportion of late presentation and/or recurrences (around 10 %) of locally advanced prostate cancer. Additionally, sporadic reports of synchronous pelvic neoplasms have been published with various treatment strategies to optimize patient survival. Pelvic exenteration is a technically demanding surgical procedure that is performed for locally advanced, recurrent or synchronous pelvic malignancies. The role of pelvic exenteration in locally advanced prostate cancer has been controversial, as there is a lack of strong statistical evidence to support its role. Despite this, studies have outlined benefits of this procedure, especially in the presence of synchronous pelvic cancers or for palliative indications. Despite advances in surgical care and techniques, pelvic exenteration remains a high-risk procedure with troublesome complications. However, with better patient selection, multi-disciplinary team (tumour board) involvement and surgery being performed in specialist high volumes centres, rates of morbidity and mortality have substantially reduced.