Oncological Outcomes of Primary Prostate Cancer Patients Treated with Focal Cryotherapy. Does Gleason Impact Results?

Purpose Focal cryotherapy is a minimally invasive treatment for localized prostate cancer (PCa), but its medium-term oncological outcomes, particularly in relation to baseline Gleason Grade Group (GG), remain understudied. This study evaluates its efficacy and the impact of baseline Gleason score on recurrence-free survival. Methods A retrospective analysis included 111 patients with localized PCa treated with focal cryotherapy between 2014 and January 2025. Patients with prior treatments or follow-up < 12 months were excluded. All patients underwent MRI and transperineal biopsy, with cryotherapy performed using the Visual ICE Cryoablation System. Confirmatory biopsies were recommended at 12–24 months post-treatment. Recurrence was classified as in-field (treated or adjacent areas) or out-field (non-adjacent areas). Any recurrence-free survival was defined as the absence of positive biopsy or additional treatment, while radical treatment-free survival was defined as the absence of whole-gland treatment (e.g., radical prostatectomy, radiotherapy), androgen deprivation therapy, metastasis, or death. Outcomes were compared between patients with baseline GG 1 and GG > 1. Results Median follow-up was 35 months (IQR 24–49). Confirmatory biopsies were performed in 78% of patients (n = 87), revealing in-field recurrence in 14% and out-field recurrence in 23%. No significant differences in recurrence rates were observed between GG 1 and GG > 1 patients (p = 0.9 for in-field; p = 0.8 for out-field). The 3-year any recurrence-free and radical treatment-free survival rates were 63% and 85%, respectively, with no significant variation by baseline GG. Conclusion Focal cryotherapy demonstrates favorable medium-term oncological outcomes for localized PCa, with no significant differences in recurrence-free survival based on baseline Gleason score. These findings support its role as a viable treatment option for patients seeking to minimize treatment-related morbidity.