I am looking for information on alternatives to surgery or radiation.

Alternatives to radiation or surgery depend on your prostate cancer case.

Yes, you can get focal therapy in a variety of ways but you need to have a Gleason 3+4 or 4+3 without a huge prostate. It is preferred that the cancer is isolated in one side of the prostate. The cancer also has to be isolated to the prostate. Be aware that there is a high rate of recurrence with 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

Af the UCSF prostate cancer forum on 4-17-26 Dr. Cooperberg had slides with this information

UCSF Results: first 135 HIFU patients

• 54% recurrence (41% in-field)

• 4% progression by 1 year, 16% overall

• IPSS (urinary obstruction) 6 before, 6 after

• SHIM (erection function) 16 before, 13 after (p=0.11)

• Major drivers of recurrence: GG3, high Decipher

Trade-offs

• Overall focal therapy is associated with minor side effects, but high rates of recurrence

• Inadequate energy delivery?

• Inadequate field of treatment?

• New cancer development?

• Others?

• Understanding the high recurrence rates and trying to improve them is a major area of research focus.

• Focal therapy does not burn bridges: RP, RT, even additional focal therapy are possible if necessary

Summary thoughts

•Focal ablation has a growing role for very carefully selected cases.

• Side effects rates are low but recurrence rates are high. GG3 and high Decipher are warning signs, as are high PSAD and bilateral disease.

• Focal therapy is an adjunct to active surveillance; additional treatment may well be needed down the road, but these treatments are still possible after focal.

University of California Consensus

1 Focal therapy must be acknowledged to be investigational

2. Focal therapy should be done under trial or research protocols as much as possible

3. Candidates should have at least 10 year life expectancy, GG2 or low-volume GG3, stage T1 or 2, and PSA < 10 or PSA < 20 and PSAD
< 0.15

4. Candidates need an MRI-guided confirmatory biopsy before treatment

5. Follow-up biopsy at 12 months is essential

Sounds like you are in the early stages of decision-making. Lots (and lots) of factors will influence your decision-making process: PSA history, prostate size, your age, your health, Gleason scores, IPSS score, etc etc. Depending on this complex collection of factors, you may have many options. Get second opinions from centers of excellence. I've had good sessions with Memorial Sloan Kettering docs but there are several highly-regarded centers that offer good advice and consults via Zoom.
Unless your numbers are demanding a relatively quick choice, take time to learn. Use this (and other) forums to hear from others in "the fraternity."

@jeffmarc do they ever use Tulsa or IRE to ablate the whole prostate, minus nerve bundles and margins of course, but to basically ablate the whole thing? Thank you.

@bobgolf Hi. IRE is truly focal --best candidate is favourable 3+4 intermediate with one visible tumour limited to one side of the prostate. I read that they will sometimes target a second on the other side. It's about "visible" tumour though.

By contrast, Tulsa Pro can be partial ablation but mostly whole gland (aka "subtotal") in that they spare critical structures (ie nerve bundles). The procedure can even go over the tumour (index lesion) twice to "kill it dead" so to speak.

Whole gland Tulsa Pro ablation is about 90%. And it's that 10% spared for critical structures' tissue that you ---wonder about....

To be fair, if you're doing IRE and have (say) just an index tumour zapped with 1/2 to 3/4+ of the prostate left untreated there's a lot more "wonder about".

Cheers.

@kjholz thank you!

@bobgolf
Here’s some more information on how IRE is used.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6464181/

Brachytherapy is an alternate to what many in the US call "radiation". As opposed to the various forms of external beam, brachy is where the radiation source is placed inside the prostate so that the full power only hits prostate tissue. This therapy is declining in use in the US, whereas in many other jurisdictions, eg. Europe, and Canada, its use is expanding. Apparently it takes more time to become expert at performing it, it costs a lot less, and the room where it is performed doesn't have that space age look to it with some huge device propelled by high priced marketing promises the latest and greatest treatment. The main thing its got going for it are decades of studies with data showing how good it is. Brachy is used by itself in less risky cases, and is often used in combination with external beam for unfavorable, high, or very high risk cases. I've heard docs who don't appear to be expert at brachy refer to external beam with brachy boost as the "gold standard".