Predictors of Early and Late Oncologic Failure After Primary Prostate Cryoablation for Localized Prostate Cancer

The factors that predispose to unsuccessful prostate cryoablation for prostate cancer (PCa) remain uncertain. We assessed whether specific clinical or procedural features relate to early (≤ 24 months) or late (> 24 months) oncologic failure after primary cryotherapy.

A total of 221 men underwent primary cryoablation between January 2021 to October 2025 for PCa. Failure-free survival (FFS) was defined as the absence of biochemical recurrence (PSA ≥ nadir + 2 ng/mL), radiologic/histologic progression, or initiation of salvage therapy. Events were classified using a 24-month landmark; analyses of late failure were restricted to men who were event-free at 24 months and had follow-up beyond this timeframe. Regression analyses were restricted to men not exposed to neoadjuvant therapy. Candidate predictors included clinical, imaging, and procedural variables and were analyzed using Firth logistic regression.

Early biochemical failure occurred in 9 patients (4.1%) and late recurrence in 18 (8.1%); corresponding FFS events were 12 (5.4%) and 22 (9.9%). Functional outcomes were preserved (continence > 90%; erectile recovery ≈ 30%). Survival remained favorable throughout follow-up. In multivariable analysis, whole-gland ablation was inversely associated with early failure (OR 0.17; P = .022). Late failure was associated with ISUP grade group (OR 4.11; P = .039), with an additional protective association observed for whole-gland ablation (OR 0.06; P = .044).

Early failures reflected the extent of ablation while later outcomes were driven by tumor grade. This temporal distinction offers a clearer interpretation of recurrence patterns after cryotherapy and may support more informed selection and surveillance strategies.