Complications after all surgical procedures are divided into early (during or immediately after surgery) and late (during follow-up or longer). After surgery, the patient always has a urinary catheter (bladder tube) inserted and is always unable to work for several weeks.

The most common early complications include bleeding during the procedure with the need for blood transfusions, injury to the rectum during the procedure, formation of a fistula between the bowel and the urinary tract, which requires the establishment of a temporary bowel outlet (stoma) to heal this complication. Other early complications include the formation of a clot in the veins of the lower limbs (deep vein thrombosis - up to 8% of cases), pulmonary embolism (up to 7%). Up to 15% of patients have a narrowing of the urethra-bladder junction (stricture) after surgery, which must be resolved surgically.

The most common long-term complications are erectile dysfunction and urinary leakage (incontinence).

Both complications are caused by the disruption of the nerves and blood vessels that run along the prostate gland, which may be severed or damaged during surgery by ligation or a thermal process (called coagulation).

Up to 15% of patients have to use an incontinence device after surgery, usually pads, nappies, but also condom urinals or a penis clip. Medications for incontinence are not yet available, but so-called spasmolytics can relieve urine leakage by reducing involuntary bladder contractions and increasing bladder capacity. Urinary leakage can also be reduced during recovery and is expected to improve up to 24 months after surgery.**

Treatment of erectile dysfunction should be started as soon as possible; a drug form may be tried, but it onlyy achieves limited effectiveness. The application of an erectile stimulant directly into the erectile bodies with a thin needle, which the patient learns in a specialist clinic and then performs himself, is much more effecctive. As a last resort, a prosthesis can be implanted in place of the erectile bodies in order to allow the penis to be erect. Erectile dysfunction can also be corrected during the first two years of surgery. ***

**/***https://www.cus.cz/pro-pacienty/diagnozy/karcinom-prostaty/

Hormone therapy works differently amidst different men. It cannot be determined in advance which side effects will occur and to what extent. In some men, side effects may be very mild or may not occur at all.

Side effects of hormone therapy are mainly associated with the loss of libido and sexual interest, erectile dysfunction and impotence. In addition, fatigue, hot flashes, emotional instability, depression, a decrease in muscle tone, loss of active muscle mass, decrease in mental activity and overall vitality occur at an increased rate.

Long-term endocrine treatment of prostate cancer is associated with the loss of muscle mass and the development of sarcopenic type obesity with implications for cardiovascular toxicity and bone loss, development of osteoporosis and the risk of fractures.

Tolerance to radiotherapy is individual and the side effects may occur to varying degrees. Fatigue and drowsiness may occur as a general reaction of the body to any radiation treatment, less often with the lack of appetite. However, these problems are rather rare.

One possible side effect is a reaction in the bladder. This will manifest itself as more frequent urination, burning or cutting when urinating. You can limit these side effects of treatment by taking enough fluids and filling your bladder adequately during radiation. Most of these problems will go away within 2 months of stopping radiation.

Another common side effect is a reaction in the rectum and bowel. Blood in the stool, diarrhea, urging to pass stools, bloating, and abdominal pain may occur. If these side effects occur, always contact the facility where the radiation was performed and they will recommend treatment or refer you to a specialist who is experienced in examining the bowel after radiation.

Reducing the risk of side effects is the most common reason for choosing proton radiotherapy (radiation). It has minimal toxicity (side effects) and recent published data describe serious side effects in less than 1% of patients in large cohorts of patients. Compared to published data for photon radiotherapy and surgery, side effects are significantly lower than for other methods. Compared to surgical treatment, proton radiotherapy also does not lead to impotence in the majority of patients (99%) and thus significantly improves the quality of life of patients. Last but not least, proton therapy in high-risk prostate cancer allows irradiation of the pelvic lymph nodes where subclinical involvement is likely. In this clinical situation, the dosimetric and clinical advantage of proton radiotherapy is most pronounced in the sparing of abdominal organs, especially intestinal villi.

Proton radiotherapy is a fully outpatient treatment and there is no need for incapacity for work during the treatment. Compared to conventional photon therapy, which takes several weeks and is often accompanied by a variety of unpleasant side effects, it lasts for only 5 days for early stages or 21 days for advanced prostate cancer.