Background: Carcinoma of the prostate (CaP) has a relatively high burden in men of African descent. Most patients present at advanced stages of the disease, necessitating androgen deprivation therapy commonly by bilateral total orchidectomy (BTO). A scrotal incision (such as the scrotal median raphe incision) is traditionally used for the BTO. Though the infrapubic incision is a known alternative, there is however paucity of literature to validate its use, hence the need for this study. Aim and objectives: This study compared the infrapubic incision to the scrotal median raphe incision for BTO in the management of advanced CaP in Ile-Ife, Nigeria. The specific objectives were to compare the operative duration, early post-operative complications and early cosmetic outcome of the infrapubic incision to those of the scrotal median raphe incision.Patients and Methods: This was a prospective, comparative, hospital-based study. Consecutive, consenting men scheduled for BTO in the management of advanced CaP were alternately placed in either of two groups, A or B, while being recruited into the study. The patients in group A had BTO using an infrapubic incision while those in group B had BTO using a scrotal median raphe incision. They were all followed up for 3 months post-operatively. A proforma specially designed for the study was used for data collection and analysis was done using the statistical package for social sciences (SPSS) version 21. For all statistical tests, p < 0.05 was considered significant. Results: Seventy-one patients were studied, 36 in group A (infrapubic incision group) and 35 in group B (scrotal median raphe incision group). The operative duration for BTO using the infrapubic incision was significantly longer than that for the scrotal median raphe incision (mean difference: t=3.47, p=0.0009). Pain in the first 3-days after BTO was more severe with the infrapubic incision (p=0.000), but the pain had become comparable to that from the scrotal median raphe incision by the 7th day after surgery. Overall, wound haematoma occurred in 11 (15.5%) patients. A breakdown of these cases revealed significant differences in both groups with 3 (8.3%) patients in group A and 8 (22.9%) patients in group B developing wound haematoma in the post-operative period. Surgical site infection (SSI) occurred in a total of 4 (5.6%) patients. Comparison between both groups showed that SSI occurred in one (2.8%) patient and 3 (8.6%) patients of groups A and B respectively. The infrapubic incision had significantly better cosmetic outcome at 3 months after surgery (p=0.0016). There was no significant difference in the patient satisfaction with the incision used for the BTO in both groups. Conclusion: BTO can be successfully carried out with either a scrotal median raphe incision or an infrapubic incision. Though the infrapubic incision is associated with a relatively longer operative duration and worse early post-operative pain, it however has less risks of wound haematoma and SSI. It equally has a better early cosmetic outcome compared to the scrotal median raphe incision. Keywords: Advanced carcinoma of the Prostate, Bilateral total orchidectomy, Infrapubic incision, Scrotal median raphe incision, Ile-Ife, Nigeria.