Everyone knows the three most important words in real estate: location, location, location. For our clinical team at the Sperling Prostate Center, the three most important words in focal therapy for prostate cancer (PCa) are precision, precision, precision!

For localized PCa (still contained in the gland), compare whole gland (radical) approaches with focal approaches. The purpose of a radical approach is to kill not only the tumor but also any other microscopic PCa cells that may be present elsewhere in the prostate, thus “sacrificing” the entire gland. In turn, there is a risk of collateral damage to the prostate’s intimate neighbors—bladder, rectal wall, nerve bundles that control erection—depending on which treatment method is used.

On the other hand, the purpose of a focal approach is to selectively target the tumor, plus a margin of safety. Since focal treatment does not affect the entire gland, normal prostate function is spared. The area and size of the tumor determines which section of the prostate is involved, which can also risk collateral damage. However, focal treatment has the lowest side effect statistics of all treatments.

Focal treatment is generally done as an outpatient procedure. Methods range from minimal to noninvasive. If the tumor and safety margin are completely encompassed by the zone of ablation, the tumor is eradicated. Patients are then monitored by imaging and PSA tests on an ongoing schedule assigned by the doctor. This is to make sure that no cancer was missed, or that a new tumor hasn’t started somewhere else. One advantage of focal therapy, unlike radical treatments, is that future localized treatments are still an option if need arises.

Where does precision come in?

For thousands of PCa patients, focal therapy is an excellent choice, but many wonder how we can be so sure we’re hitting and completely annihilating the target. Well, thanks to incredible advances in multiparametric MRI (mpMRI) and MRI-targeted biopsy, we can visually pinpoint the location and extent of the target. We also take into account additional information so we know the characteristics of the tumor, and if ablation is an appropriate treatment method. As the authors of a 2025 article from JAMA state, “The ongoing development of novel biomarkers, clinical, genomic, or artificial intelligence tools offer hope for more precise tools to distinguish ‘the wolf from the sheep,’ as current risk stratification within [traditional] D’Amico risk groups remains insufficient to guide treatment decisions with absolute confidence.”^[i] 

To further ensure precision, at our Center we use special mpMRI software to visually watch the ablation as it’s occurring so we know that we’re destroying the targeted tumor while avoiding damage to nearby healthy tissues and structures. And, when treatment is complete, we use mpMRI to verify the death of tumor activity. Precision, precision, precision at every step along the way.

Our Center is equipped with a powerful 3T magnet that offers state-of-the-art MRI, and our expert team achieves the highest standards of clinical excellence, experience, and compassionate care. We specialize in Focal Laser Ablation and TULSA. If you or a loved one is interested in precision PCa treatment, contact us to find out how we can help.

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] Osinski T, Malshy K, Joseph J. Overtreatment in Prostate Cancer: An Overused Term. JAMA Intern Med. 2025;185(7):901.