114 Background: Modern primary focal cryosurgery (PFC) has emerged as a primary therapy option for localized and minimal low-risk prostate cancer (PCa), achieving good local cancer control and survival outcome. The aim of this analysis was to report on the experience of PFC in our tertiary referral center in the management of localized PCa. Methods: We identified a consecutive series of patients that underwent PFC for localized PCa at our institution between 8/2000 and 1/2014. Demographics, PSA levels and Gleason scores before primary treatment and at time of recurrence were assessed; BDFS, OS, and DSS were assessed. BCR was defined by the Phoenix (PD) and Stuttgart Definitions (SD). Results: A total of 126 patients were included in the analysis, with a median follow-up of 40.3 (0.8-116, IQR 41) months. Median age was 73.5 (range 45-92, IQR 9) years. Median initial serum PSA level was 6.0 (1-44.5, IQR 3) ng/ml. Median primary and secondary Gleason score on initial biopsy was 3 (3-5, IQR 1) with a median sum of 6 (6-10, 1), and 15% (2-95%, IQR 0) of biopsy tissue involved with cancer. Median number of biopsy cores was 12 (2-32), with a median of 1 (1-12, IQR 1) core affected by cancer. Median PSA nadir post-treatment was 1.3 (0.1-13.1, IQR 2) ng/ml. According to PD and SD, 24 and 37 patients had BCR after a median of 14.9 (3.4-91.3, IQR 17) and 13.0 (2.9-90.3, IQR 11) months. Overall 4-year-BDFS was 83% and 73% by PD and SD, respectively. 5-year OS and DSS was 95%, and 99.2%. Of patients that met BCR criteria, almost 25% were proven to be negative on biopsy, confirming over-estimation of failures. Patients that recurred had significantly higher initial median PSA levels (8.5 vs. 5.8 ng/ml; p<0.01) and PSA-nadir (2.1 vs. 1.0 ng/ml; p<0.05). Conclusions: Our analysis confirms PFC being a good option with low rate of morbidities for patients with localized PCa, with excellent BDFS and DSS at a long follow-up of 40 months. Controversy exists regarding criteria of BCR-definitions after focal therapies. More stringent definitions, such as the SD, especially in a focal cryosurgery setting, significantly over-estimate failure rates, and prostate biopsy seems to be the only reliable means to assess for recurrence at this point.