Conventionally, confirmation of clinically significant prostate cancer (csPCa) (Gleason grade group >/= 2) involves an initial multiparametric magnetic resonance imaging (mpMRI) followed by biopsy. Prostate biopsy incurs inherent risks of infection, bleeding, patient discomfort, and a 6 week delay before robotic assisted laparoscopic radical prostatectomy (RALP). We explored the feasibility of immediate RALP in men with PIRADS 5 lesions without preceding biopsy. After obtaining institutional review board approval, a prospective analysis was conducted on 235 patients with PIRADS 5 on mpMRI from December 2018 to February 2023. Patients were divided into 2 groups: Group NoBiopsy (biopsy not done before RALP, cases, n=118) and Group YesBiopsy (biopsy done before RALP, controls, n=117). Baseline pre-operative, intra-operative and post-operative parameters were analyzed. Functional outcomes were monitored at 1, 3-, 6-, 9-, and 12-months follow-up post-RALP. Statistical analysis was performed using SPSS and STATA. 95% of cases and 87.17% controls had csPCa on final pathology post-RALP. Multivariable analysis did not find significant association between biopsy status and csPCa. Abnormal digital rectal examination (DRE), family history, pre-operative PSA and MRI lesion volume predicted csPCa. Significant differences were observed in console time (NoBiopsy vs YesBiopsy, 60±10 vs. 70±9 minutes, p < 0.001) and estimated blood loss (80±20 vs. 100±30 mL, p < 0.01) between groups. At 6 months post-RALP, 96% of men in Group NoBiopsy were continent, compared to 88% of men in Group YesBiopsy (p < 0.04). All men in the study cohort were continent (0 pads) at 12 months post-RALP. 98% of cases and 92% of controls at 9 months and 12 months, respectively, were able to have penetrative sex with or without PDE-5 inhibitors post-RALP. RALP without antecedent prostate biopsy in men with PIRADS 5 lesions demonstrated substantial csPCa detection rates and superior functional outcomes, warranting further validation.