SUMMARY:
Focal Laser Ablation (FLA) is a minimally invasive treatment for localized, low- to intermediate-risk prostate cancer that uses targeted laser heat to destroy tumors while preserving surrounding healthy tissue. FLA offers cancer control comparable to many traditional treatments while significantly reducing the risks of urinary incontinence, erectile dysfunction, and other side effects, leading to improved quality of life. The benefits and the steps of the procedure are described, while noting that the primary limitations are the need for careful patient selection and the relatively limited availability of long-term (10+ year) outcome data.
What is Focal Laser Ablation (FLA)?
Focal Laser Ablation (FLA) is a minimally invasive treatment for localized prostate cancer. It uses precision laser heat energy to target and destroy specific tumors without damaging surrounding healthy tissue. It is used to treat low- to intermediate-risk cancer tumors. It significantly lowers the risk of urinary incontinence and erectile dysfunction.
In short, “Focal laser ablation is an emerging treatment paradigm for prostate cancer that aims to successfully eradicate disease while also reducing the risk of side effects compared to whole-gland therapies.”[i]
Key terms: What is focal therapy for prostate cancer?
Here are brief definitions of key terms you may come across as you learn about focal therapy and Focal Laser Ablation for prostate cancer.
Focal therapy – Focal therapy for localized prostate cancer ablates (destroys) an MRI-visible tumor plus an extra tissue margin, while sparing healthy tissue in order to preserve urinary and sexual function.
Focal Laser Ablation (FLA) or Laser Focal Therapy (LFT) – An MRI-guided application of precise laser heat for tumor destruction.
Localized prostate cancer – Prostate cancer that is contained in the gland (has not begun to spread beyond the prostate capsule).
Candidate for focal therapy – Two main qualifications for focal therapy are 1) MRI-visible localized prostate cancer, and 2) biopsy proven low-to-intermediate risk cancer. Only a physician can determine if a patient is a candidate based on these plus additional clinical factors, e.g., PSA, age, Gleason grade, etc.
Active surveillance – A strategy to hold off on immediate treatment while monitoring the prostate cancer via periodic PSA tests and prostate MRI.
Multiparametric MRI (mpMRI, 3T mpMRI) – Combined results of 3 parameters (MRI imaging sequences) to differentiate between healthy prostate tissue and cancer, with specific cancer characteristics revealed in order to plan treatment.
Real-time in-bore MRI-guided biopsy – The most accurate live image-guided diagnosis using minimal biopsy needles targeted directly into a suspicious MRI-visible area.
Fusion-guided biopsy – Use of previously captured prostate MRI images merged with real-time transrectal ultrasound to sample suspicious prostate areas. Compared with real-time MRI, fusion targeting risks compromised accuracy, often requiring additional systematic biopsy samples.
BlueLaser™ – Brand name for proprietary MRI services developed by the Sperling Prostate Center.
Cancer control and failure-free survival – In a short-term study of 120 Focal Laser Ablation patients, 83% were retreatment-free at 1 year.[ii] A longer-term study reported results at 10 years: 98% overall survival, 100% prostate cancer-specific survival, and 99% metastasis-free survival.[iii]
Urinary and erectile side effects – All prostate cancer treatments have some risk of tissue damage leading to urinary incontinence (leaking, dripping, sense of urgency) or erectile dysfunction (inability to have an erection sufficient for penetration). Compared to whole-gland surgery or radiation, focal therapy greatly reduces side effect risks. A 12-month study found no significant change in urinary or sexual function after treatment.[ii]
How does Focal Laser Ablation compare with other localized prostate cancer treatments?
Focal Laser Ablation provides comparable failure-free survival on a par with whole gland treatments like surgery and radiation. What sets a focal therapy like Focal Laser Ablation apart is the significant difference in quality of life. Focal treatment greatly reduces the side effect risks of whole gland modalities.
A 10-year study (170 patients) presented to the American Urological Association reported less than 1% risk for each side effect (urinary incontinence, erectile dysfunction, and infection) after treatment.[iii]
Average 5-year cancer control
| Whole gland treatment | Focal therapy |
| Radical prostatectomy 89-73%
Radiation – all modalities 75 – 99% (depends on disease risk level) |
Focal therapy across all modalities
Focal laser ablation 83%[iv] (all risk disease levels) |
Average side effect risks
| Side effect rates | Prostatectomy | Radiation | Focal Laser Ablation |
| Urinary incontinence | 5-30% | 12 – 33% | < 1% |
| Erectile dysfunction | 30-70% | 40% + (progressive) | < 1% in most data |
| Dry orgasm | 100% | 16% + (progressive) |
Not significantly affected |
| Bowel problems | No risk associated | 4 – 15% | Uncommon |
| Late onset secondary cancers | No radiation exposure | 27.4% (cumulative) |
No radiation exposure |
What are the pros of Focal Laser Ablation
Focal Laser Ablation offers distinct benefits over whole gland treatments as well as Active Surveillance.
- Precise tumor ablation (destruction) while sparing healthy structures
- Pinpoint accuracy compared with other focal therapies
- Advanced 3T MRI enables planning, treatment guidance, validated tumor coverage, temperature monitoring, and confirmation of ablation effect after treatment
- Minimally invasive
- Outpatient
- Local anesthesia
- No surgery or radiation
- Very low risk of urinary and sexual side effects
- Rapid return to normal activities
- Keeps all future treatment options open if cancer recurs
- FDA approved for prostate treatment
- Unlike Active Surveillance, patients have peace of mind knowing their cancer is destroyed
What are the cons of Focal Laser Ablation
Focal laser ablation has virtually no downside for appropriate candidates. Determining candidacy requires thorough and accurate diagnosis. As with any procedure, this requires appointments for 3T multiparametric MRI and MRI-guided prostate biopsy into the visible suspicious area.
Some patients have expressed concern that 10+ year data on Focal Laser Ablation is still limited. However, intermediate term studies (5-8 years) offer compelling results showing Focal Laser Ablation as comparably effective with whole gland treatments while offering superior quality of life after treatment.
Pros and cons of Focal Laser Ablation
| Pros | Cons |
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What steps are involved in the procedure?
There are five steps involved in Focal Laser Ablation.
Step 1: Preparation for the procedure
- Diagnosis confirmed by multiparametric MRI and biopsy
- Identification and mapping of the target
- Bowel cleanse and antibiotic administration
- Local anesthesia administration
Step 2: Patient positioned in the MRI scanner
- Patient lies face down on the MRI table
- Urinary catheter inserted to protect the urethra
Step 3: Placing the laser fiber guide
- Insertion of a small, hollow needle to the tumor, through the rectum or perineum
- Insertion of a laser optic fiber through the needle into the tumor
- Continuous MRI scans confirm successful mapping and fiber placement
Step 4: Activating Ablation
- The physician turns on the laser to deliver targeted thermal energy.
- Tumor instantly destroyed via high heat generated by the laser energy
- Ongoing MRI thermometry (heat monitoring) and urinary catheter assure protection of the urethra and neighboring healthy structures
Step 5: Treatment Effect Verified and Patient Discharged
- Immediate post-procedure contrast-enhanced MRI verifies complete tumor destruction.
- Removal of laser fiber and needle guide
- In-office recovery for a few hours
- Patient returns home (outpatient means no overnight stay)
Who is a candidate for Focal Laser Ablation?
Candidates for Focal Laser Ablation are patients whose 3T multiparametric MRI reveals a lesion that is suspicious for significant prostate cancer. If confirmed by biopsy, it should be low-to-intermediate disease that is confined to the gland, and have a volume that can be safely encompassed by laser energy (plus a margin of safety) without damaging urinary or sexual function.
Frequently asked questions
Q: Are more patients choosing Focal Laser Ablation?
A: Definitely! Focal Laser Ablation is growing as an alternative to whole gland treatment and Active Surveillance because long-term data on other focal modalities (e.g., cryotherapy, HIFU) has increased confidence in this approach. In fact, a 2026 analysis of patients in U.S. cancer centers that offer focal therapy for intermediate risk prostate cancer found a significant trend in focal treatment from 2010 to 2013. The authors report that “…laser ablation increased from 14.6% to 45.8%…” while other methods such as HIFU increased from 5.6% to 35.1%.[v]
Q: What is the recurrence rate after Focal Laser Ablation?
A: According to a systematic review of 12 published studies (total 421 patients who had Focal Laser Ablation), the average recurrence rate of clinically significant prostate cancer was 15% (average time frame not specified).[vi] Compare that with average recurrence rates within 8 years of prostatectomy: 21% for low-risk disease, 25% for favorable intermediate-risk disease, and 41% for unfavorable intermediate-risk disease.[vii]
Q: What are my treatment choices if prostate cancer comes back?
A: If significant prostate cancer comes back after Focal Laser Ablation, and it is still confined within the prostate gland, all treatment choices are possible, including a repeat focal treatment, a whole gland treatment (prostatectomy or radiation), and Active Surveillance. Thorough diagnosis is essential, as described above. Doctor-patient discussion will inform the decision.
Content reviewed by Dr. Dan Sperling, M.D., DABR — updated August 2026
Bibliography
Bushati Y, Guo AA, Muston BT, Bushati A et al. Focal laser ablation in prostate cancer: a systematic review and meta-analysis. BJU Int. 2026 Feb;137(2):251-259.
David R, Buckby A, Kahokehr AA, Lee J et al. Long term genitourinary toxicity following curative intent intensity-modulated radiotherapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis. 2023 Mar;26(1):8-15.
Katz AJ, Kang J. Quality of Life and Toxicity after SBRT for Organ-Confined Prostate Cancer, a 7-Year Study. Front Oncol. 2014 Oct 28;4:301.
Tian Z, Zhu Y, Sun X, Cui Q. Meta-analysis of radical prostatectomy outcomes: Oncological control and functional recovery in prostate cancer patients. Medicine (Baltimore). 2025 Aug 8;104(32):e43444.
Tiruye T, David R, O’Callaghan M, FitzGerald LM, Higgs B, Kahokehr AA, Roder D, Beckmann K. Risk of secondary malignancy following radiation therapy for prostate cancer. Sci Rep. 2023 Nov 16;13(1):20083.
Treutwein, M. (2020). Untersuchungen zu den Auswirkungen der ausgleichskörperfreien Bestrahlungsmodalität in der Strahlentherapie anhand des lokalisierten Prostatakarzinoms und des Hypophysenadenoms. https://doi.org/10.5283/EPUB.43370
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] Wenger H, Yousuf A, Oto A, Eggener S. Laser ablation as focal therapy for prostate cancer. Curr Opin Urol. 2014 May;24(3):236-40.
[ii] Walser E, Nance A, Ynalvez L, et al. Focal laser ablation of prostate cancer: results in 120 patients with low- to intermediate-risk disease. J Vasc Interv Radiol. 2019;30(3):401-409.e2.
[iii] John Feller*, Greenwood B, Jones W, Toth R et al. PD17-01 Outpatient trans-rectal MR-guided laser focal therapy phase ii clinical trial: ten-year interim results. Journal of Urology [Internet]. 2020 Apr 1;203(Supplement 4):e369.
[iv] Chao B, Lepor H. 5-Year Outcomes Following Focal Laser Ablation of Prostate Cancer. Urology. 2021 Sep;155:124-129.
[v] Cosenza A, Nguyen DD, Qian Z, Bernardino R, Olson A, Cole AP, Davies BJ, Gandaglia G, Jacobs BL, Trinh QD. Focal Therapy for Prostate Cancer. JAMA. 2026 Aug 13:e2612411.
[vi] Bushati Y, Guo AA, Muston BT, Bushati A et al. Focal laser ablation in prostate cancer: a systematic review and meta-analysis. BJU Int. 2026 Feb;137(2):251-259.
[vii] Das S, Luu M, Terris M, Klaassen Z et al. Contemporary risk of biochemical recurrence after radical prostatectomy in the active surveillance era. Urol Oncol. 2024 Jun;42(6):175.e1-175.e8.
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.
