Kind of depends on what you mean by extreme. If you're in Grande Prarie, Winnepeg or Saskatoon where it's -40 during the winter you'll want to take some precautions to keep the batteries warm (just like you would with any car battery). For the kind of cold you'll experience in the lower 48 there isn't much to worry about.
The Prius is the easiest car to start in very cold weather because there is no starter motor and no starter. Instead one of the large motor/generators spins the engine without fuel or spark until it reaches a speed where it would run on its own (around 900-1000 rpm) then spark and fuel are added to two of the cylinders and later to the other two (Compared to an old fashioned car where there is a small motor that's just barely able to turn the engine on the hopes that the fuel will ignite at just the right time and create enough force to start the engine running--not an easy task at -40). This also means that the Prius never experiences a cold start so the engine leads an easy life.
I've found the Prius starts the same at -20 as it does at +70 (-20 is the lowest I've had my Prius parked outside overnight in).
Like any car, the Prius will lose about 25% of the mpg when the temperature gets down to 0F and more when it's well below zero. This is normal, but most folks don't realize it because most cars don't have the instrumentation to tell you (and people often don't keep logbooks) so sometimes first time Prius owners are surprised (although they shouldn't be). There are several techniques to keeping the mpg up in cold weather that are discussed regularly in the Yahoo Prius groups and elsewhere.
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