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]

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.^[ii]

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 93.7 – 98% (low risk disease) 84.8 – 91.6% (intermediate risk disease) Focal laser ablation 83%[iii] (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
Precision ablation spares healthy tissue 3T MRI plans, guides, validates, monitors and confirms treatment effectiveness Minimally invasive Outpatient Local anesthesia No surgery or radiation Very low side effect risks Rapid return to normal life All future treatment options open FDA approved Peace of mind	Pre-treatment appointments to confirm candidacy Limited mature long-term (10+ years) data

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%.^[iv]

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).^[v] Compare that 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.^[vi]

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] 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.
[iii] Chao B, Lepor H. 5-Year Outcomes Following Focal Laser Ablation of Prostate Cancer. Urology. 2021 Sep;155:124-129.
[iv] 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.
[v] 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.
[vi] 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.