The locally advanced rectal tumors may need extended surgical procedures for its radical resection, like a total pelvic exenteration. The proctoprostatectomy is a rarely employed surgical procedure that is oncologically safe for selected patients, sparing them from a permanent urinary diversion. A 47 year old male presented with a lower rectum (2 cm from anal verge) adenocarcinoma. Pre-operative staging with pelvic MRI showed prostate gland invasion sparing the urinary bladder. The treatment strategy included neoadjuvant chemoradiation and a radical proctoprostatectomy. After a wide median laparotomy and negative search for extra-pelvic disease, an extended retroperitoneal lymphadenectomy down to the obturator fossas was performed. A partial encasement of the inferior vena cava was found, managed by a partial venous resection. The Retzius space is incised and a complete bladder mobilization done followed by ligation of the dorsal vein complex in the manner of a suprapubic prostatectomy. The plane between the prostate and the rectum is not develo0ped to allow the en bloc resection of the prostate with the rectum. The procedure follows as an abdominoperineal resection. The urinary reconstruction is done by means of a bladder-urethral anastomosis. The modification of total pelvic exenteration with bladder sparing is a viable option in the management of locally advanced rectal cancer associated with better postoperative quality of life.