Focal Therapy for Prostate Cancer
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Source currency note: This guide reflects medical information reviewed in June 2024. Always confirm current guidance with your healthcare professional.
Quick Answer: What is focal therapy for prostate cancer?
Focal therapy for prostate cancer is a treatment that uses heat, cold or electric current to destroy tumor cells in one area of the prostate while sparing healthy tissue. It suits cancer confined to the prostate, with intermediate risk the best fit. It has lower sexual and urinary side-effect risks than surgery but a higher risk of cancer returning. [3]
What the research says
Short-term cancer control is moderate to high. A meta-analysis of 50 prospective studies (4,615 patients) found that 86% (95% CI 82% to 89%) were free of biopsy-proven clinically significant cancer recurrence at 12 months and 81% (95% CI 74% to 86%) at 24 months. In the intermediate-risk subgroup the 12-month rate was 79%, and 5-year radical and systemic treatment-free survival was 82%. Median follow-up was only 21 months, and the studies relied on surrogate endpoints (Ślusarczyk et al., European Urology Oncology, 2025).
Serious side effects were uncommon. In the same analysis, grade 3 or higher adverse events occurred in 3% of patients (95% CI 2% to 5%), pad-requiring urinary incontinence rose by 3% (95% CI 0% to 6%) and 11% developed new erectile dysfunction (95% CI 4% to 18%) (Ślusarczyk et al., European Urology Oncology, 2025).
Most of the evidence is still early-stage. A systematic review of 72 studies (5,827 patients) covering eight energy sources found that most studies were early development-stage prospective studies. HIFU studies reported a median of 95% of men pad-free and a median of 85% with no clinically significant cancer in the treated area. The authors conclude that more high-quality evidence is needed before focal therapy can become a standard treatment (Hopstaken et al., European Urology, 2022).
Understanding Focal Therapy
Focal therapies treat only the area of the prostate where the tumor is located. The tumor must be confined to the prostate, usually on one side, without spreading to nearby tissue or organs. Each type of focal therapy uses an energy source, such as heat, cold or electric shock, to destroy tumor cells [3].
Focal therapy is an alternative to surgery or radiation, which treat the entire prostate, and to active surveillance, where your provider periodically monitors and tests the tumor for signs of spreading. For favorable intermediate-risk prostate cancer (only one intermediate-risk feature, such as a PSA between 10 and 20 or Grade Group 2, and less than 50% of biopsies positive), it is a potential middle ground between active surveillance and whole-gland treatment [3].
The goal is to destroy cancerous cells while leaving as much healthy tissue as possible, which helps minimize side effects and complications [3].
Types of Focal Therapy
Each type of focal therapy works a little differently, so your provider will explain what to expect for the type you need [3].
Therapy type | Energy source | How it works |
|---|---|---|
Cryotherapy | Cold gases | A provider freezes the tumor with cold gases |
Focal laser ablation (FLA) | Laser | Heat from a laser destroys tumor cells |
High-intensity focused ultrasound (HIFU) | High-frequency sound waves | Heat from high-frequency sound waves destroys tumor cells |
Irreversible electroporation (IRE) | Electric shock | Electrodes around the tumor deliver an electric shock that damages tumor cells |
Transurethral ultrasound ablation (TULSA) | Sound waves | Heat from sound waves destroys tumor cells |
Who Is a Candidate for Focal Therapy?
Focal therapy is not suitable for every case. It treats cancer that has a low risk of spreading and is completely contained (localized) in the prostate. Ideally, the tumor is also not near the urinary sphincter, the muscle that controls when urine is released from the bladder, or the urethra [3].
Intermediate-risk cancer: the best candidates. The cancer is aggressive enough to need treatment but has not spread to other organs.
Low-risk cancer: better managed with active surveillance.
High-risk cancer: better treated with whole-gland therapies such as surgery or radiation.
Before treatment, your provider uses tests including MRI, MRI-guided biopsy and PSMA PET scans to see whether the tumor is clearly defined and contained [3].
What Happens Before Focal Therapy?
You may need several tests and imaging studies to determine your treatment options [3]:
MRI (magnetic resonance imaging) of the prostate
MRI-guided prostate biopsy (transperineal or transrectal)
Mapping biopsy, in which your provider takes several tissue samples to map the boundaries (margins) of the tumor
PSMA PET scan, an imaging test that detects prostate-specific membrane antigen and looks for cancer that has spread to other parts of the body
How the Procedure Works
In general, a provider will follow these steps:
Put you under anesthesia so you sleep through the procedure and don't feel pain.
Insert the device into the prostate through your rectum or urethra, or with a needle through the skin.
Target the tumor with an energy source that damages and destroys cells.
Each type of focal therapy works a little differently, so your provider will explain exactly what to expect for your procedure [3].
After Treatment: Monitoring and Follow-Up
After focal therapy, your provider monitors you closely for months or years. Because only part of the gland is treated, follow-up looks for cancer that [3]:
Didn't show up on tests or imaging before treatment
Wasn't completely destroyed by focal therapy
Has come back (recurrence)
Is spreading (metastasis)
Focal therapies often require more thorough monitoring than whole-gland treatments, such as MRIs and prostate biopsies. You might need additional treatment, including surgery or radiation, if tests show that there is still cancer in the prostate [3].
Risks and Benefits
Focal therapy offers real advantages in side-effect management, but it carries specific risks. The trade-off between quality of life and the risk of cancer recurrence is a central part of treatment decisions [3].
Benefits
Less damage to healthy tissue: it spares healthy prostate tissue and surrounding structures.
A lower risk of side effects: including erectile dysfunction and urinary incontinence.
A less invasive option: it lets you manage prostate cancer while avoiding more invasive treatments.
A more proactive option: it is an alternative to active surveillance.
Potential downsides
Recurrence: it might not get rid of all cancerous cells, and focal therapies have a higher risk of recurrence.
More treatment later: if the cancer returns, you might need additional treatments.
Not for everyone: not everyone is a good candidate.
Side effects are still possible: the risk is lower, but sexual and urinary side effects can still occur.
Newer treatments: most are relatively new, so their benefit compared with surgery, radiation or active surveillance is not fully understood, and some are still considered investigational.
How Effective Is Focal Therapy?
Reported effectiveness varies widely, from about 30% to 96%, but these numbers are not apples-to-apples comparisons and the quality of the studies varies [3]. Studies measure effectiveness in different ways, such as the percentage of people who have:
Negative biopsies after treatment
No cancer progression over a set time, usually 10 years
Lower PSA numbers
Results also depend on the type of focal therapy, the tumor's location and the likelihood that the tumor will spread. Overall, focal therapies are considered less effective than whole-gland therapies such as surgery and radiation, so it is important to talk with your provider about the benefits and risks of each type [3].
Conclusion
Focal therapy offers a targeted approach for people with localized, intermediate-risk prostate cancer. By treating only the tumor, it aims to preserve healthy tissue and protect urinary and sexual function. It requires careful selection and rigorous follow-up, and it is not an option for everyone because focal therapies have been studied less than traditional treatments [3].
Your next step: if you have been diagnosed with localized prostate cancer, talk with a urologist or cancer specialist about the benefits and risks of the available treatments to decide what is right for your situation.
Frequently Asked Questions
What is focal therapy for prostate cancer?
Focal therapy is a treatment for localized prostate cancer that uses energy such as heat, cold or electric current to destroy only the area of the prostate where the tumor is located, sparing as much healthy tissue as possible. [3]
Who is a good candidate for focal therapy?
People whose cancer is confined to the prostate with a low risk of spreading. Intermediate-risk prostate cancer is the best fit, ideally with a tumor that is not near the urinary sphincter or urethra. Low-risk cancers are better managed with active surveillance, and high-risk cancers with whole-gland treatment. [3]
What are the main types of focal therapy?
Cryotherapy (freezing), focal laser ablation, high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE) and transurethral ultrasound ablation of the prostate (TULSA). [3]
Does focal therapy cause erectile dysfunction?
The risk is lower than with surgery or radiation, but sexual and urinary side effects are still possible. In a meta-analysis of 50 prospective studies, about 11% of men developed new erectile dysfunction (95% CI 4% to 18%). [3][1]
Is focal therapy as effective as surgery?
Focal therapies are considered less effective than whole-gland treatments such as surgery and radiation, and they carry a higher risk of recurrence. They offer a lower risk of side effects, and most are relatively new, so long-term benefits are less well understood. [3]
How long is recovery after focal therapy?
Recovery depends on the type of focal therapy and your own health, and your provider will tell you what to expect. After treatment you will be monitored closely for months or years. [3]
What monitoring is required after treatment?
Close monitoring with testing for cancer that was not seen before, was not completely destroyed, has come back or is spreading. This often includes MRIs and prostate biopsies as well as PSA tests. [3]
What tests are done before focal therapy?
You may need an MRI, an MRI-guided prostate biopsy, a mapping biopsy that outlines the tumor's boundaries, and a PSMA PET scan to check whether cancer has spread. [3]
Is focal therapy covered by insurance?
Coverage varies by the type of focal therapy and your insurance plan. Most focal therapies are relatively new and some are still considered investigational, so check with your care team and insurer. [3]
What happens if focal therapy doesn't work?
If tests show cancer is still in the prostate or has returned, you might need additional treatment, including surgery or radiation. [3]
Related Reading
Prostate Cryotherapy: Procedure, Side Effects and Results explains prostate cryotherapy.
Active Surveillance for Prostate Cancer: Tests, Benefits and Risks explains active surveillance for prostate cancer.
MRI-Guided Prostate Biopsy: Fusion Biopsy, Prep, Risks and Results explains the targeted prostate biopsy guided by MRI.
Gleason Score: How Prostate Cancer Is Graded and What Your Score Means explains how prostate cancer is graded from biopsy samples.
References
Ślusarczyk A, Gurwin A, Barnaś A, et al. Outcomes of focal therapy for localized prostate cancer: a systematic review and meta-analysis of prospective studies. European Urology Oncology. 2025;8(6):1653-1672. PMID 40251100. https://doi.org/10.1016/j.euo.2025.02.003
Hopstaken JS, Bomers JGR, Sedelaar MJP, et al. An updated systematic review on focal therapy in localized prostate cancer: what has changed over the past 5 years? European Urology. 2022;81(1):5-33. PMID 34489140. https://doi.org/10.1016/j.eururo.2021.08.005
Cleveland Clinic. Focal therapy for prostate cancer. Cleveland Clinic. June 10, 2024. https://my.clevelandclinic.org/health/treatments/16265-prostate-cancer-focal-therapy
Medical disclaimer
This article was prepared for general information only and is not a substitute for professional medical advice.
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