Looks like you have run into what Dr. Cooperberg Had to say about focal therapy.

At the 11/1/2025 PCRI conference the following was said by Matthew R. Cooperberg, MD, MPH Urologic Oncologist UCSF

What about focal therapy?
* The energy modality matters much less than the accuracy of the imaging - which is not there yet.
* Overall focal therapy is associated with minor side effects, but high rates of recurrence both in- and out-of-field.
* Focal therapy is not really a replacement for surgery or radiation; it is better considered an adjunct to active surveillance

You have put on a list of a whole bunch of different treatment techniques. You really have given no information about what your preferred next treatment would be. There are a lot of options. SBRT radiation with a proton machine would Keep your sexual function for a while, But any radiation can burn up the nerves that you can get spared when doing surgery. For some people that means the loss of the ability to get an erection over time. The thing is there are solutions for that, The implant is very popular and works quite well to continue getting a good erection.

You could go focal again, It might take care of it.

Your PSA jumping to 7 does say you need to do something. As you know, your BPH problem could be solved by surgery, But that has a lot of other issues, can they spare the nerves for example?

Too many options, What do your doctors have to say? Are you willing to go anywhere to get the treatment you want?