Because of continuous technical development for more than half a century, followed by better clinical results with minimal side effects, cryoablation of the prostate for localized prostate cancer has evolved as a true alternative therapeutic option in selected cases. Today's form of cryotherapy has almost nothing in common with those versions established in the 1970s and further developed in the 1990s. Nowadays it shows minimal invasiveness and high efficacy for treatment of high-risk carcinomas and failures of other therapeutic modalities. Cryoablation of the prostate is indicated if there are absolute or relative contraindications for radical surgery. In localized prostate cancer, cryoablation is the therapy of choice for salvage cases; standardisation of the procedure, definition of freeze-thaw cycles, and structured training programs have led to this status.