Prostate Cancer: Complications

Prostate cancer is one of the most prevalent cancers in American men. Based on 2021 reports from the American Cancer Society, over 248,000 new prostate cancer cases were recorded. About 34,000 of which have proved fatal. 

This cancer forms when abnormal cells in the prostate gland begin to multiply. The accumulation causes a tumor, which can then lead to multiple complications. According to urology experts, two types of complications can emerge. Complications that result from the illness itself and those from treatment. 

Although cancer treatment can successfully remove the disease and help the patient live a productive life, it can cause unwanted side effects. Whereas the illness itself can lead to problems like urinary incontinence, erectile dysfunction, and debilitating pain.

Here, you will take a closer look at prostate cancer-related complications, including some of the most practical strategies for managing them. 

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Complications of prostate cancer typically appear when the prostate has become large enough to impact the urethra. Since this type of cancer takes a long time to grow, it may take years before the patient notices any complications. 

The most debilitating complications are the result of disease progression. They are often associated with bone pain, spinal cord compression, urinary tract obstruction, coagulation disorders, and more. 

Some of the most impactful complications include:

  • Bone pain

  • Pelvic pain

  • Exhaustion

  • Urethral obstruction

  • Bloody urine

  • Ureter blockage

  • Metastasis

Most of these complications are found in advanced prostate cancer cases. Men with localized cancer often encounter urinary problems and pain. But, the longer the tumor remains in the system, the bigger the damage. Eventually, it can have a drastic impact on a person’s quality of life. 


Metastatic prostate cancer happens when the prostate cancer cells from one region spread to other sections of the body. Cancer can spread outside the prostate gland, through the lymph system, tissue, and blood. Prostate cells can spread to other organs, particularly the bladder. But, they can move even further, especially towards the spinal cord and bones. 

Data estimates that metastasis is responsible for around 90% of cancer deaths. For that to happen, the malignant cells need to detach from the primary tumor and interfere with the lymphatic and circulatory systems. They evade the immune system and proliferate far-away organs. 

When cancer spreads to the organs and bones (bone metastases), it can cause the following complications:

  • Spinal cord compression

  • Weakness in the legs and arms

  • Back, thigh, or hip stiffness

  • Bone fractures

  • Debilitating pain

  • Hypercalcemia with vomiting, confusion, and nausea

These complications are often managed with proper medication. Prostate cancer patients can receive injectables, like the denosumab (Xgeva) or bisphosphonates.

Every medical intervention comes with potential complications. Prostate cancer treatment is no exception. The ideal scenario would be for the patient to treat the tumor with little-to-no side effects. However, everybody is different. And their system will react in a unique way. 

That’s why it’s critical to recognize the complications and take the proper course of action. With an approach such as this, patients will make the most of carcinoma treatment. 

The go-to treatments for prostate carcinoma are radical prostatectomy, radiation therapy, and testosterone-reducing therapy. Each treatment or therapy can trigger its own complications. 

Radical Prostatectomy Complications

Radical prostatectomy is a surgery used to take out the prostate gland and its surrounding tissues. That typically includes some lymph nodes and the seminal vesicle. 

  • Radical prostatectomy has an 82% to 90% survival rate. While with metastasis-free, the survival rate of the surgery ranges from 76% to 82%. 

Prostatectomy can treat localized prostate cancer. It is used as a sole-treatment or can be combined with hormone, chemotherapy, or radiation. There are different prostatectomies. You have an open prostatectomy, laparoscopic prostatectomy, perineal prostatectomy, and robot-assisted prostatectomy.

Open prostatectomy uses a typical incision under the belly button. In laparoscopic radical prostatectomy or radical retropubic prostatectomy, surgeons create a couple of small incisions in the abdomen. This prostatectomy is performed on the outer side of the body and is viewed through a video screen. 

Whereas with perineal prostatectomy, the prostate gland is removed through an incision in the perineum. Robot-assisted prostatectomy uses an advanced robotic system to treat the body. Although they are very different prostatectomy procedures, they still have something in common – complications. 

Any prostate surgery can cause long-term complications. With prostatectomy, these include:

Urinary obstruction 

Blockage of the urinary passage is a common complication from surgery. Experts estimate that 14% to 20% of men use absorbent pads after surgery to manage their urinary incontinence in the long haul. If the patient also suffers from anastomotic stricture, then they will need additional surgery. 

Erectile dysfunction 

Impotence is another known complication of prostate cancer surgery. Luckily, most patients regain their sexual function in a couple of months or 2 years after treatment. 

Urinary incontinence 

With an incidence rate from 1% to 40%, urinary leakage is a troublesome and persistent problem for men who undergo radical prostatectomy. The incontinence can affect their self-esteem and quality of life.

Cancer recurrence 

Despite the high treatment success rate, some patients have a failed surgery. Around 20% to 40% of those who received the treatment experienced a biochemical recurrence post-surgery. 

According to clinical trials, out of 11,522 men, in their late 60s, who had radical prostatectomy, 28% experienced at least one postoperative complication. The odds of prostatectomy complications increased with age, reaching 35% for those over 75 years. To manage the health issues, doctors will do a follow-up treatment. 

Radiation Complications

Radiation therapy, particularly external beam radiation therapy, kills the cancer cells. It destroys their genetic material and stops the cells from dividing and growing. When healthy cells get in the way of radiation treatment, that’s when people can experience complications. 

The goal of the therapy is to destroy the carcinoma while sparing as much of the healthy tissue as possible. However, in some cases, that can prove difficult. As a result, people can develop complications such as:

Bowel problems 

The treatment to the pelvic region can damage the rectum lining and cause swelling and inflammation. This is known as radiation proctitis. Because of the damage, people can experience mucus and blood in their bowel motions, discomfort, and the need to relieve themselves more often.

Urinary obstruction

Radiotherapy, especially prostate brachytherapy, can cause blockage and swell in the urethra. This can cause urinary retention. In some cases, the urethra becomes narrow, typically referred to as a urethral stricture. 


Radiation therapy to the pelvis can cause bladder irritation. When paired with chemotherapy medication, the treatment can damage the nerves and result in poor bladder control. Medication or injections can help with incontinence.


This treatment could interfere with blood flow to the penis and reduce testosterone levels, causing erectile dysfunction. These complications, however, start to develop 6 months to 1-year post-treatment. 

Cancer recurrence 

Individuals who miss radiation treatment sessions are at higher risk of the disease returning. 

To manage the complications, patients can practice practical coping mechanisms. Such as maintaining a nutritious diet, doing physical activity, and getting enough sleep. For more serious complications, doctors could suggest additional treatment. 

Testosterone-Reducing Therapy Complications

Hormonal therapy (androgen suppression therapy) is a treatment meant to reduce the levels of androgens in the system. It uses surgery or medicine to get the desired result. The treatment can put prostate carcinoma in remission and soothe the symptoms of progressive cancer. 

It can even enhance the positive effects of other therapies, like radiation. Many prostate carcinomas in their early-stage need normal testosterone levels to grow. However, castration-resistant prostate cancer does not. In this case, chemotherapy is the most practical alternative.

With that being said, the lack of testosterone can cause unwanted side effects. The drugs used during treatment are called LHRH agonists or GnRH agonists.

Both medications and surgical castration, also known as orchiectomy, can cause complications. People can develop:

  • Osteoporosis

  • Uncontrolled weight gain

  • Heart illness

  • Hot flashes

  • Diabetes

  • Muscle mass loss and weakness

  • Erectile dysfunction and poor libido

  • Poor concentration or memory


Some carcinomas use hormones to develop. Doctors are calling them hormone-sensitive cancers. Therapy blocks or reduces these hormone levels and allows the system to manage the malignancy. However, the treatment can also increase the likelihood of bone thinning. 

Osteoporosis is defined by bone thinning. It predisposes the bones to fractures, particularly hip and spine bones. Low testosterone or hypogonadism is a significant risk factor for developing osteoporosis. 

Fortunately, specialized testing can help assess the patient’s susceptibility to bone fracture. Bone mineral density scans (BMD’s) can help spot the problem and decrease the risk of fractures. 

Uncontrolled Weight Gain

Many people gain weight after receiving steroids and chemotherapy. The extra pounds may keep piling up after chemo, particularly if the individual has taken hormonal therapy. Based on studies, a slight increase in weight during treatment is not often a real problem. 

However, any significant changes can add a lot of pressure to the person’s well-being. Due to the reduction in hormone levels, the body gains fat, reduces metabolism, and decreases muscle. Addressing the weight gain can be done via physical activity and a nutritious diet. 

Heart Illness

Prostate carcinoma requires testosterone to thrive and grow. Hormone treatment is meant to decrease the testosterone the body produces, therefore slowing cancer’s growth. According to research, the drastic reduction in testosterone levels can make people susceptible to heart disease. But, data is limited.

One 2015 meta-analysis recorded a 40% higher risk in non-fatal cardiovascular disease in men with prostate carcinoma. These patients took androgen deprivation therapy (ADT). Another 2011 research showed contradictory results. Scientists found no connection between ADT and cardiovascular mortality. 

Therefore, it is difficult to determine the exact impact of hormone therapy on heart health. We know that testosterone reduction can cause hypertension, pro-inflammatory factors, and abnormal lipid profiles. So, patients with pre-existing health problems, like diabetes, need to pay extra attention to their overall health. 

Hot Flashes

Hot flashes are a typical complication of androgen deprivation. They are quite like postmenopausal hot flushes. According to experts, they can cause discomfort and profuse sweating, which can be particularly problematic. But, the sweating usually subsides the moment the testosterone levels are back to normal.


Based on reports from the Endocrine Society, men with prostate carcinoma could be at risk of developing diabetes after receiving ADT. ADT can stop the production of male hormones that fuel cancer growth. But it can also increase the risk of a metabolic condition. 

Muscle Mass Loss and Weakness

Reducing testosterone levels can cause sarcopenia (muscle mass loss) and dynapenia (muscle strength loss). In fact, the treatment has been found to cause muscle bulk loss in men. When you pair that with physical inactivity, you can feel extremely weak and tired. 

To counter these effects, it is best to change your diet, exercise more, and work on your muscle mass. With a proper exercising routine and nutritious meals, you can get your muscles back on track. Supplementation and pharmacological interventions may come in handy. But, make sure to consult with a specialist first. 

Erectile Dysfunction and Poor Libido

At least a third of men have sexual problems when they get diagnosed with prostate cancer. Localized treatment can significantly reduce the prevalence of sexual dysfunction. It can help with dysfunction, loss of desire, and orgasm changes. 

But, those who receive ADT have the worst rates of sexual dysfunction, explains the National Library of Medicine. Just 3 to 4 months post-therapy, the desire for sex decreases. Some might even experience irreversible damage to the erectile tissue of their penis. 

In about one-half of patients, erections don’t recover. Even if they discontinue the therapy. Despite intermittent ADT providing some sexual function recovery, the serum testosterone needs 9-12 months of therapy to recover. This kind of health complication can be difficult to treat except with implant surgery. 

Poor Concentration or Memory

Testosterone can have a direct impact on cognition. Small-scale studies show that ADT can impact cognition. In fact, from 47% to 69% of men on ADT declined in at least one cognitive area. Most experienced poor executive functioning. 

However, there is mixed evidence on whether the therapies can affect thinking, concentration, and memory. Some studies show that the therapy can significantly affect cognition. While others believe the treatment can trigger only mild cognitive changes. 

Whatever the impact may be, the end result is clear. It seems that the treatment can have some level of impact on cognition. 

Long-Term Outlook 

Every treatment has risks. But, when it comes to prostate cancer treatment, the benefits often outweigh the risks. When you take a look at the relative survival rate, you will quickly notice the results. According to statistics, prostate cancer has quite high survival rates.

Prostate carcinoma 5-year relative survival rate

The relative survival rate compares patients with the same stage and type of cancer to the general population. For instance, if the 5-year survival rate for a certain stage of prostate cancer is 90%, it means those affected are 90% as likely to live for 5 years as those without cancer. 

Other than that, treatments can kill many malignant cells scattered throughout the body. Plus, each management strategy can do a lot more when paired with other treatment options-making them the go-to choice for managing the illness.

Furthermore, every treatment is tailored towards the affected individual. It targets specific cancer and tries to manage it from the inside. Doctors often recommend cancer treatment to destroy microscopic illnesses. These illnesses can be at the edge of the primary tumor and might not be seen with the naked eye. 

Basically, men with prostate cancer have a good chance of enjoying a long life. In some cases, treatment isn’t necessary. In those with low-risk prostate cancer, the illness can be treated immediately with radiation or surgery. 

Most experts believe that external radiation, surgery, and brachytherapy have almost the same cure rates. These treatments are often recommended for those in the earliest cancer stages. As you can see, they have plenty of benefits to offer.

But, the truth is, not everyone is eager to start systematic therapy. Especially those who are already in the late stages of cancer. Younger men are typically more willing to accept prostate treatment. They choose to treat the illness if they are offered the best chances for recovery. 

Simply put, the results are highly individualized. The effects and side effects vary from one person to the other. Therefore, knowing the risks can help sort out which treatment option could be the ideal one for you. 

Important Points to Remember When Selecting a Treatment

What you do need to know is that the treatments have both risks and benefits. It’s a good idea to consider all of them. Also, every person experiences cancer differently. So, if one treatment proved highly beneficial for someone else, it doesn’t mean it will do the same for you. And vice versa.


To detect prostate cancer, you will need to do a prostate biopsy. You will take a biopsy if you have a lump or increased PSA levels. During a biopsy, the doctor will obtain a sample of the suspicious tissue directly from the prostate gland. Then, they will examine it under a microscope.

For additional testing, transrectal ultrasound might be necessary. The ultrasound helps locate abnormalities in the prostate, rectum, and surrounding tissues. 

If the biopsy or ultrasound detects prostate cancer, you will need to choose the proper treatment. Sometimes, you will need to do a prostatectomy or brachytherapy. In other cases, active surveillance will only be necessary. 

People with low-grade and low-risk prostate cancer (with a 6 Gleason Score) take active surveillance. This is a practical monitoring approach for localized stages. But, when the illness poses a potential health risk, then more rigorous treatment becomes necessary.

Doctors base their treatment on recent research and recommendations. Your doctor can advise you on the best form of treatment that’s tailored to your needs. Including the approved drugs that will benefit your system. Regardless of the stage of cancer. 

What you can do is:

  • Look into every treatment possibility.

  • Make sure you are familiar with the benefits and risks of the therapy.

  • Ask how the treatment will affect you personally.

  • Collect the necessary information that will help you make the right choice.

Remember, it is best to make that decision together with your healthcare provider. It’s a good idea to be involved in the decision-making process and explore all the possible benefits and risks of treatment. What matters is that you make an informed decision. 

Individuals who refuse treatments take hospice. Hospice workers provide supportive and palliative care; they let cancer run its course. If the affected person can benefit from treatment, then it’s best to accept the help. Overall, the benefits highly outweigh the risks.


Because of how close it is to multiple vital structures, prostate cancer and treatments can disrupt your sexual, bowel, and urinary system. People can experience complications from surgery, hormone, and radiation treatment. 

But, that doesn’t mean you should skip treatment. On the contrary, those who receive treatment can live long lives. Due to its high treatment and survival rate, it is among the most curable forms of cancer. 

When you have to decide on the type of care you receive, you should take both its benefits and risks into account. Whether you decide to take brachytherapy, radiation, or surgery, you will understand the risks that come with it. So don’t forget to consult with your oncologist on the most efficient treatment for your health problem. 

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  4. Horst Zincke. (1994). Long-Term (15 Years) Results After Radical Prostatectomy For Clinically Localized (Stage T2c Or Lower) Prostate Cancer. The Journal of Urology. Retrieved from:
  5. Shabbir M. H. Alibhai. (2005). 30-Day Mortality and Major Complications after Radical Prostatectomy: Influence of Age and Comorbidity. Journal of the National Cancer Institute. Retrieved from:
  6. Thomas King. (2012). Post-Radical-Prostatectomy Urinary Incontinence: The Management of Concomitant Bladder Neck Contracture. Hindawi Journal. Retrieved from:
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  8. Thomas N. Seyfried. (2013). On the Origin of Cancer Metastasis. National Institutes of Health. Retrieved from:
  9. Winchester Hospital. Restoring Sexual Function After Prostate Surgery. Retrieved from:
  10. Nirmish Singla. (2014). Post-prostatectomy incontinence: Etiology, evaluation, and management. National Institutes of Health. Retrieved from:
  11. Rafael Tourinho-Barbosa. (2018). Biochemical recurrence after radical prostatectomy: what does it mean. Retrieved from:

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