Focal Therapy for Prostate Cancer

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Focal therapy is a minimally invasive treatment that uses energy sources to remove small, slow-growing prostate cancer tumors that have not spread beyond the prostate. It is less likely to cause the side effects associated with prostate removal surgery and radiation therapy but requires ongoing active surveillance to watch for prostate cancer tumors that may remain, return, or spread.

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The Benefits of Focal Therapy

Traditionally, men with localized prostate cancer – meaning it has not spread outside the prostate gland – who do not opt for active surveillance are treated with surgery or radiation therapy. These approaches remove or radiate the prostate gland and can potentially damage nerves and urinary and bowel passages. As a result, they are often associated with side effects that impact sexual, urinary, and bowel function.

Focal therapy uses advanced imaging, such as ultrasound and MRI, to target the exact location of the tumor and minimize the impact of treatment on the surrounding, healthy prostate tissue and structures. As a result, it is less likely to cause erectile dysfunction, urinary incontinence, and bowel problems. 

Because focal therapy does not treat the entire prostate, there is an increased risk that cancer may be left behind or may return. For this reason, regular follow-up appointments are required to monitor for cancer recurrence. If a tumor appears again, repeat focal therapy or another option may be recommended to treat the prostate cancer. 

Our Location

Our focal therapy experts treat people at Duke University Hospital in Durham.

Types of Focal Therapy

Focal therapy uses different types of energy sources to kill cancer cells and destroy tumors. These outpatient procedures require anesthesia. In most cases, one or more needles are inserted into the area between the anus and the scrotum and are used to treat the cancer. Focal therapies require anesthesia and are performed with ultrasound or MRI guidance by a specialist trained in focal therapy. Your doctor will recommend the procedure that is right for you based on tests that determine the stage, location, and size of the prostate cancer tumor, as well as your medical history.


Your urological oncologist inserts a needle-thin metal probe into the prostate and uses cool gas to freeze and destroy cancerous tissue.


Irreversible Electroporation (IRE), commonly known as a “NanoKnife” procedure, uses small needles inserted into the prostate gland under guidance with specialized imaging. The needles deliver electrical pulses that destroy cancer calls.

Gold Nanoshell-Localized Photothermal Ablation

Gold nanoparticles are administered through an IV and attach to cancer cells. Needles are then inserted to reach the tumor and generate heat that is absorbed by the particles, killing the cancer cells.

High Intensity Focused Ultrasound (HIFU) 

This is the only focal therapy option that does not treat the cancer by needle. HIFU involves the insertion of a specialized ultrasound probe into the rectum. The probe emits heated ultrasound waves to destroy cancer cells in the prostate. 

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After Focal Therapy Treatment

You may experience general soreness, burning, and/or light bruising in the days after your appointment. It is normal to see small amounts of blood in your urine for several weeks after the procedure. Your prostate may swell, which can make urination difficult. A temporary catheter can be placed in your urethra if your doctor is concerned about your urinary function. It can be removed during a visit with your provider within the following few days. 

Follow-up appointments will help your care team monitor your healing. They may include blood tests, imaging tests, and prostate biopsy. 

Consistently Ranked Among the Nation’s Best Hospitals

Duke University Hospital is proud of our team and the exceptional care they provide. They are why we are once again recognized as the best hospital in North Carolina, and nationally ranked in 11 adult and 9 pediatric specialties by U.S. News & World Report for 2023–2024.

Possible Side Effects

Your ability to have and maintain an erection may diminish immediately after focal therapy but should return to normal as you heal. Rehabilitation plays a key role, and the earlier it starts, the better your chances of a full recovery. The same is true for urinary function. While focal therapy rarely has a lasting impact on urinary function, performing Kegel exercises can strengthen the muscles that help you urinate. The sooner you feel comfortable flexing these muscles as part of a rehabilitation routine, the faster your recovery will be.

This page was medically reviewed on 02/09/2022 by