We evaluate the safety, efficacy, and oncological outcomes of early palliative photoselective vaporization of the prostate (PVP) by GreenLight high-performance system (HPS) 120-W laser in patients with acute urinary retention (AUR) induced by advanced prostate cancer (PCa). A total of 39 advanced PCa patients with AUR who underwent PVP were enrolled in this retrospective study. Baseline parameters, perioperative, and postoperative complications were reviewed. The functional outcomes were evaluated at 1, 3, 6, and 12 months after surgery using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, peak urinary flow rate (Q (max)), and postvoid residual urine volume (PVR). At baseline, mean age was 72.8 +/- 6.8 years and mean prostate-specific antigen (PSA) level was 45.2 +/- 26.9 ng/mL. The average energy consumed was 171.2 +/- 72.3 kJ during a mean operative time of 46.3 +/- 13.7 min. Mean catheterization duration was 3.3 +/- 0.8 days. Mean hospitalization time was 5.2 +/- 0.5 days. Compared with the preoperative values, there were significant continuous improvement in IPSS, QoL score, Q (max), and PVR at all time points of follow-up. The mean PSA nadir was 0.33 +/- 0.15 ng/mL and the mean time to PSA nadir was 10.3 +/- 2.5 months. Nine patients (23 %) eventually developed hormone refractory prostate cancer. No patient experienced severe intraoperative and postoperative complications. Our preliminary investigation shows that GreenLight HPS 120-W laser PVP is a safe and effective treatment for advanced PCa patients with AUR. Patients may obtain some oncological benefits from tumor cytoreduction by early palliative PVP.