SUMMARY
Monitoring after focal therapy relies on yearly PSA testing, with mpMRI used to evaluate any suspicious rises. This combination helps identify whether new cancer is present or if the PSA change is due to benign prostate conditions. Early clarification allows patients and physicians at Sperling Prostate Center to make informed decisions while keeping all treatment paths open.
Why is a diagnosis of prostate cancer scary?
A diagnosis of prostate cancer can cause fear and anxiety. As with any cancer diagnosis, there is natural worry that the disease is life-threatening. However, when prostate cancer is found early and treated, success rates at five years approach 100%. Knowing that the cancer is under control can ease fear.
However, patients also worry about treatment-related side effects like incontinence and impotence. Radical prostatectomy (whole gland surgical removal) can affect quality of life after treatment. One study found that 14-25% of prostatectomy patients reported bothersome urinary leakage at 10 years after surgery.[i] Another showed that 15 years after prostatectomy, 87% of patients reported erectile dysfunction.[ii]
To calm these fears, many patients diagnosed with localized prostate cancer are drawn to minimally invasive focal therapy as a precision alternative to prostatectomy. The Sperling Prostate Center offers focal therapy to control cancer by destroying the index lesion (usually the largest tumor) while sparing healthy gland tissue.
Can focal therapy control cancer while reducing side effects?
Although there are not yet long-term cancer control statistics, a team of researchers report “no clinically relevant difference in cancer control conferred by focal therapy compared to radical therapy at 6 years.”[iii] In other words, focal therapy success rates for controlling cancer are roughly equal to surgery.
Focal therapy also has fewer side effects. Dr. Dan Sperling points out that patients who choose focal therapy do so for two main reasons. First, its ability to control cancer brings peace of mind. Second, compared to surgery, focal therapy’s low side effect rates mean better quality of life after treatment. Published research shows no significant changes in pretreatment urinary or sexual function a year after focal laser ablation (FLA).[iv]
Another advantage of focal therapy is rapid recovery. Since outpatient methods like FLA are minimally invasive, patients have little down time after the procedure, and quickly return to normal activity. In short, focal therapy eases both fears: prostate cancer-related death, and poor quality of life.
Why are prostate cancer patients monitored after prostate treatment?
It is a fact that no prostate cancer treatment comes with a 100% guarantee of cure. This includes both whole gland (radical) treatments as well as focal therapy. This is why every prostate cancer patient who undergoes either radical or focal treatment should have an annual PSA (prostate specific antigen) test. It is the earliest way to monitor for new prostate cancer activity after treatment.
However, after focal therapy a suspicious PSA result does not automatically mean prostate cancer is back. Since focal therapy spares healthy prostate tissue, noncancerous conditions can affect the portion of the gland that was not affected by focal treatment. Things like normal gland enlargement (benign prostatic hyperplasia or BPH), prostatitis, or even ejaculation may cause a rise in PSA.
To determine the cause of a higher-than-expected PSA after focal treatment, more specific information is needed. This is where imaging comes in.
What kind of imaging can clarify a suspicious PSA after focal therapy?
A special type of MRI called multiparametric MRI (mpMRI) has an essential role to play if an annual PSA test result shows a suspicious rise after focal therapy. A noninvasive mpMRI generates a high resolution, detailed 3D portrait of the prostate gland and its treatment zone.
There are three reasons to follow an unusual PSA with mpMRI:
- It offers a visual evaluation of changes in the treated area(s) so it can confirm the absence of significant prostate cancer.
- If new cancer has begun in an untreated area of the gland, or if missed cancer is growing in the treated area, mpMRI detects this so the doctor can see it.
- If seen, the scan results guide decisions such as need for a biopsy or further treatment.
Annual monitoring means any new cancer activity is detected at the earliest possible time, allowing a new treatment plan to be made. Focal therapy keeps all future treatment options open.
After focal therapy, should mpMRI also be done annually along with a PSA test?
After focal therapy, each doctor has a protocol for when the first follow-MRI should be done. This is to confirm the treatment effect. However, after the initial follow-up MRI, most experts do not recommend a routine annual mpMRI.
Instead, it is more typical to continue with annual PSA tests, knowing that a high or rising result will trigger an mpMRI scan. Further clinical action will then depend on the PSA test and the mpMRI results. In all cases, if a monitoring mpMRI reveals an area that appears to be clinically significant prostate cancer, a real-time MRI-guided targeted biopsy can be done to evaluate the suspicious cells.
Conclusion
To sum up, focal treatment gives reassurance that the cancer can be controlled with little-to-no impact on quality of life. The important point to remember is that annual PSA monitoring followed by multiparametric MRI can detect and clarify cancer activity at the earliest possible time. This allows a doctor and patient to develop a treatment plan at a point when all treatment options are still open.
Frequently asked questions
Q: What does a rising PSA mean after focal therapy?
A: A rise in PSA after focal therapy does not automatically mean cancer is back. Focal therapy leaves healthy prostate tissue untreated. This portion of the gland continues to function normally, which also means it can become infected, grow larger with normal aging-related changes, and be stimulated by sexual activity—all of which can cause a risk in PSA.
Q: Does focal therapy close off future treatment options?
A: Focal therapy does not shut the door on future options if prostate cancer comes back. A patient can still qualify for a radical prostatectomy, radiation, another focal treatment, and in some cases simply go on Active Surveillance. Choice of treatment will depend on clinical results (PSA, MRI, biopsy) and patient preference after all testing is completed.
Q: Can any newly diagnosed prostate cancer patient have focal therapy?
A: While focal therapy holds great appeal for newly diagnosed patients who are worried about the side effects of whole gland treatments like prostatectomy, focal therapy is not appropriate for every patient. Several factors influence a treatment plan, such as the size, location, and aggression level of the cancer. The Sperling Prostate Center offers expert MRI-based diagnostic services to thoroughly evaluate candidacy for focal therapy.
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated October 2025.
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] https://www.urologytimes.com/view/long-term-study-compares-adverse-events-from-prostate-cancer-treatments
[ii] Resnick MJ, Koyama T, Fan KH, Albertsen PC et al. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med. 2013 Jan 31;368(5):436-45.
[iii] van Son MJ, Peters M, Reddy D, Shah TT et al. Conventional radical versus focal treatment for localised prostate cancer: a propensity score weighted comparison of 6-year tumour control. Prostate Cancer Prostatic Dis. 2021 Dec;24(4):1120-1128.
[iv] Walser E, Nance A, Ynalvez L, Yong S, Aoughsten JS, Eyzaguirre EJ, Williams SB. Focal Laser Ablation of Prostate Cancer: Results in 120 Patients with Low- to Intermediate-Risk Disease. J Vasc Interv Radiol. 2019 Mar;30(3):401-409.e2.
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.
