Focal therapy (focal ablation) for localized prostate cancer has emerged as an alternative to radical (whole gland) treatments. It is also an alternative to Active Surveillance. As a result, it holds much appeal for patients. However, not every newly diagnosed patient with localized prostate cancer is a candidate for this type of procedure.

The Sperling Prostate Center offers MRI-based diagnosis to evaluate potential candidates. Their expert team provides MRI-guided treatment methods for qualified patients, and assists in patient decision-making to ensure which treatment choice is most appropriate for the individual.

How does focal therapy compare to radical treatments?

Focal therapy is uniquely different from whole gland radical prostatectomy, radiation or ablation. Instead, focal treatment is a minimally invasive approach that targets only the index lesion (main tumor) while sparing the rest of the gland. It is also called subtotal treatment (less than the whole gland).

At 5 years, focal treatments offer cancer control comparable to radical treatments; at the same time, sparing health gland tissue results in less damage to urinary, sexual and bowel function.^[i] As a result, focal therapy generally has significantly fewer side effect risks than radical treatment. This aspect appeals to patients when considering their choice of treatment.

How does focal therapy compare to Active Surveillance (AS)?

In one respect, focal therapy is very similar to AS because both approaches require a monitoring protocol. Patients who choose AS receive a surveillance schedule that includes regular PSA blood test at prescribed intervals as well longer intervals for multiparametric MRI (mpMRI) scans.

The purpose of the AS protocol is to identify any increase in cancer activity at the earliest possible time. When an increase is detected, the next step is an immediate mpMRI. If the mpMRI results reveal a change, the next step is a biopsy.

Similarly, after a patient has received a focal therapy, the index lesion has been destroyed. However, the untreated areas of the prostate may contain microscopic cancer cells, or the treated areas may contain cancer cells that survived the treatment. In either case, there is a chance, however small, that such cancer cells will become more active.

Therefore, as with AS, the patient will receive a similar monitoring schedule. If new cancer activity is identified, next steps include a biopsy and, if necessary, a re-treatment plan. However, since current data suggests that focal therapy has similar cancer control to radical treatment at 5 years, probability is low that monitoring will discover new cancer activity. Still, it’s always better to be safe than sorry.

Who is a candidate for focal therapy?

Candidates for focal therapy are patients diagnosed with localized, low- to favorable intermediate-risk disease. There is agreement among experts that factors to consider for eligibility are Gleason score, tumor volume, location of tumor, and the number of MRI-visible and biopsy confirmed cancers.^[ii]

Also, other factors should be taken into account, e.g., co-existing medical problems, lifestyle considerations, and patient preference. Patients may be drawn to focal treatment, especially if they worry about the side effects of radical treatment, or they aren’t comfortable with Active Surveillance because they don’t like the idea of cancer growing in their body.

Am I a candidate for focal therapy?

Patients who wonder if they are eligible for focal therapy must be evaluated at a center having a) experienced focal therapy clinicians, and b) appropriate diagnostic and treatment technology.

The Sperling Prostate Center is a top-tier facility for MRI-based diagnosis and image-guided focal treatments. Dr. Dan Sperling, a recognized expert in Focal Laser Ablation and other methods, meets with each patient to go over his diagnosis and images. Dr. Sperling takes time to explain in detail why or why not a patient is a candidate for focal therapy. He also explains all treatment for which a patient may be a candidate, including Active Surveillance, and assists in guiding the best match.

Frequently Asked Questions: Focal Therapy

Q: How are focal treatments done?

A: Most often, image-guided focal ablation for localized prostate cancer is performed on an outpatient basis. This is because all focal methods are minimally invasive so no hospital stay is needed.

Under image guidance such as real-time MRI or real-time ultrasound, ablation is directly targeted to the index lesion in order to destroy it completely.

Anesthesia choice depends on the type of procedure. Some procedures only require local anesthesia (with or without conscious sedation), while others may require general sedation administered by IV.

Special software is used to monitor the ablation as it occurs. Imaging is used immediately afterward to confirm the treatment effect.

Q: What ablation methods are there?

A: There are several minimally invasive ways to deliver ablation to a tumor. Most common energy forms are laser, focused ultrasound, cryotherapy (freezing), IRE (irreversible electroporation), or photodynamic (light-sensitized chemical).

        Access methods are either transrectal (through the rectum), transurethral (into the penis through the urine passage into the prostate), and transperineal (through the outer skin below the scrotum).

Q: Does insurance cover focal therapy?

A: Not all insurance carriers cover focal therapy, and not all centers participate with insurance. However, in many cases, focal therapy may be covered all or in part by insurance. Check with your provider and your insurance company.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

References

[i] “How focal therapy outcomes compare to established treatments at 5-10 years.” The Focal Therapy Clinic, locations in the UK. Oct. 6, 2025. https://www.thefocaltherapyclinic.co.uk/blog/how-focal-therapy-outcomes-compare-to-established-treatments-at-5-10-years/
[ii] van Luijtelaar A, Greenwood BM, Ahmed HU, Barqawi AB et al. Focal laser ablation as clinical treatment of prostate cancer: report from a Delphi consensus project. World J Urol. 2019 Oct;37(10):2147-2153.

About Dr. Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.