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High incidence of urological complications in men dying from prostate cancer. BACKGROUND: The incidence and clinical characteristics of urological adverse events suffered by patients with lethal prostate cancer (PCa) toward the end of life are not fully understood. METHODS: A search of our hospital medical registry identified 3816 individuals diagnosed with PCa, among whom 243 died from the disease and 144 died from other causes (n = 387). We retrospectively reviewed the 387 patients who had died to determine the incidence of PCa-related urological complications, associated factors, and subsequent palliative interventions. RESULTS: Major urological complications that required therapeutic intervention were observed in 28.4 % of PCa patients dying from the disease itself, whereas such complications were much less frequent (4.3 %) in PCa patients dying from other causes. Urological complications were associated with local recurrence in men who underwent prostatectomy, lower irradiation dose in men who underwent radiotherapy, and pretreatment higher T stage and absence of metastasis in men who underwent androgen deprivation therapy (ADT) as the primary treatment. Patients who received long-term ADT for localized disease had the highest risk for urological complications. Therapeutic intervention was highly effective for palliation. CONCLUSION: Urological adverse events are very common in PCa patients who are dying from the disease. Prevention or early palliation should be considered in patients at high risk of PCa-related urological complications.