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

[INTRODUCTION] 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.

[PATIENTS AND METHODS] 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.

[RESULTS] 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).

[CONCLUSION] 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.