Focal Versus Whole-Gland Cryoablation Therapy in High-Grade Prostate Cancer: A Single-Institution Retrospective Study

Background and objectivesHigh-grade prostate cancer carries substantial mortality risk, yet evidence supporting cryoablation in highrisk disease remains sparse.This study evaluates intermediate-term biochemical recurrence-free survival (bRFS) in patients with high-risk prostate cancer (PCa) undergoing primary focal (FC) or total gland cryoablation (TC), and assesses whether Gleason grade group predicts treatment failure. MethodsIn this single-center retrospective cohort study, 135 patients with D'Amico high-risk prostate cancer (GGG4, n = 85; GGG5, n = 50) underwent FC (n = 36) or TC (n = 99) from 2013 to 2024.Pathologic grade was confirmed by transrectal or transperineal saturation biopsy with histologic mapping; multiparametric MRI was used for lesion localization.Organ-confined disease was confirmed by staging with CT, bone scan, MRI, and PSMA PET.The primary endpoint was biochemical recurrence, defined per RTOG-ASTRO Phoenix criteria as a PSA rise of 2 ng/mL above nadir.Kaplan-Meier analysis with two-sided log-rank testing compared bRFS between grade groups within each cohort. Key findings and limitationsMedian follow-up was 36 months (IQR 19-58).At 48 months, bRFS was 69.8% and 50.0%for GGG4 and GGG5 in the FC cohort, and 71.6% and 55.0% in the TC cohort.No statistically significant difference in bRFS was identified between grade groups in either modality (FC p = 0.60; TC p = 0.23), though the study was underpowered for this comparison, particularly in the focal cohort, where only six patients had GGG5 disease.Further limitations include a single-center retrospective design, absence of a control arm, and reliance on PSA kinetics over post-operative biopsy in most patients. Conclusions and clinical implicationsBoth FC and TC achieved meaningful intermediate-term disease control in selected high-risk PCa patients.Prospective multicenter trials with standardized protocols and extended follow-up are needed to formally establish cryoablation's role in this population.