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Severe side‐effects are rare but may occur years after radiation therapy following radical prostatectomy. Therefore, the study sought to estimate the long‐term risks of severe late toxicities in an unselected, nationwide cohort. The study population comprised all men undergoing radical prostatectomy between 1997–2016 in the Prostate Cancer database Sweden (PCBaSe) (n=40,962). The largest differences were seen for late toxicities affecting the urinary tract. The groups were similar regarding intestinal toxicity, other secondary malignancies, and non‐prostate cancer mortality. Adjustments for preoperative tumor risk factors did not significantly affect the rate ratios. Severe late toxicity after postoperative radiation following radical prostatectomy predominately affects the bladder and can appear many years after radiotherapy.
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