Concierge urology · UK
Focal therapy for prostate cancer — the tissue-preserving middle ground.
Ablation of the visible tumour only. The rest of the prostate, the urethra, the sphincter and the neurovascular bundles stay where they are — so continence and potency usually do too. NICE-guided, BAUS-endorsed, and only after a proper MRI and mapping biopsy.
Why patients choose us
- 01
A middle ground, honestly explained
Focal therapy sits between active surveillance and radical treatment. We spell out where it fits, and where it does not.
- 02
MRI and mapping biopsy first
No focal treatment without multiparametric MRI and a transperineal template mapping biopsy — the two studies that make focal safe.
- 03
Independent, and free
We are paid by no clinic, so the recommendation — HIFU, cryotherapy, IRE or radical — is impartial and costs you nothing.
Indicative pricing
What focal therapy costs privately in the UK.
Indicative ranges across our partner NICE-approved centres. Send the diagnosis and we quote firm figures across two or three modalities.
In short
Focal HIFU in our network: £15,000–£25,000, home in 1–2 days.
| Modality | Indicative range | Typical duration | Discharge |
|---|---|---|---|
| HIFU (Sonablate / Focal One) | £15,000–£25,000 | 2–3 h under GA | Same-day / 1 night |
| Cryotherapy (focal) | £12,000–£20,000 | 2 h under GA | Same-day / 1 night |
| Irreversible electroporation (NanoKnife) | £15,000–£25,000 | 2–3 h under GA | 1 night |
| Focal brachytherapy (LDR seeds) | £12,000–£20,000 | 2 h under GA | Same-day |
| TULSA (transurethral ultrasound ablation) | £15,000–£22,000 | 2–3 h under GA | 1 night |
| Multiparametric MRI + mapping biopsy | £2,500–£4,500 | Two visits | 7–10 days |
| Consultation with focal-therapy urologist | £300–£500 | 45 min | Same visit |
Prices vary by centre, by modality, by anaesthetic, and by whether MRI and mapping biopsy are already done. NHS provision at NICE-approved centres — UCLH, Imperial, the Royal Marsden and others — is expanding, and we say when the NHS route is the sensible one.
The problem
Not every prostate cancer needs the whole prostate removed.
Many men with intermediate-risk disease are still offered a straight choice between watchful waiting and radical treatment. Focal therapy is the middle ground — and it is under-offered in general urology clinics.
-
Told it is radical or nothing?
For MRI-visible unilateral Gleason 3+4=7, focal therapy is an evidence-based third option that most general urologists do not offer.
-
Worried about continence and potency?
Prostatectomy incontinence risk is real. Focal therapy keeps the sphincter and usually the nerves — with a small retreatment risk in return.
-
Not sure which modality fits?
HIFU, cryotherapy, IRE, brachytherapy or TULSA — the right one depends on where the tumour sits, not on which clinic you happen to be sent to.
The journey
From MRI to structured follow-up — what happens, in order.
One clinician from first message to the mandatory 12-month biopsy — and the honest conversation about repeat focal or salvage if it is needed.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
Day-case or one-night stay
Phase 3 · After
PSA, MRI, mandatory biopsy
- 01
Before
You send us the diagnosis
A short, confidential form. PSA history, MRI report, biopsy Gleason grade and location, and what matters to you about continence and potency.
- 02
Before
We come back with a recommendation
Within one working day: whether focal therapy fits, which modality suits the tumour location, and how it compares to prostatectomy and radiotherapy for your case.
- 03
Before
MRI and mapping biopsy confirmed
If imaging or mapping biopsy is missing or older than 12 months, we arrange it first — focal therapy is only as safe as the map it works from.
- 04
On the day
Admission and anaesthetic
Day-case or one-night stay under general or spinal anaesthetic. Consent, marking and a chat with the urologist and anaesthetist.
- 05
On the day
The ablation itself
1–3 hours in a specialist theatre. Ultrasound or MRI-guided ablation of the visible tumour only — the rest of the prostate, urethra, sphincter and neurovascular bundles are preserved.
- 06
On the day
Catheter and discharge
A urethral catheter for 5–14 days depending on modality. Home the same day or the next morning, with written aftercare.
- 07
After
PSA, MRI and mapping follow-up
PSA and MRI at 6 and 12 months, then annually. A repeat template biopsy at 12 months is mandatory, then per protocol.
Typical end-to-end: 3–4 weeks from enquiry to ablation. Full recovery: 4–6 weeks. Structured follow-up: 5 years.
Who it suits
Who focal therapy is — and is not — for.
The patient profile focal therapy earns its place in, plus the one group who should not be talked into it.
-
MRI-visible Gleason 3+4=7 (Grade Group 2)
The classic focal-therapy candidate — intermediate-risk disease visible on multiparametric MRI and confirmed by targeted biopsy.
-
Select Gleason 4+3=7 (Grade Group 3)
Some 4+3 tumours are still suitable if the disease is unifocal, MRI-visible and outside the sphincter and neurovascular bundles.
-
Unilateral or unifocal disease
One MRI-visible lesion, or two close lesions on the same side. Diffuse bilateral disease is better treated radically.
-
PSA under 20 ng/mL
A PSA that fits localised disease. Higher PSAs raise the chance of tumour Pulse Atlas cannot see, and shift the balance to radical treatment.
-
Life expectancy over 10 years
Focal therapy earns its keep over the next decade — younger, fitter men gain most from preserving continence and potency.
-
Wants to preserve continence and potency
Men who want to avoid the incontinence risk of prostatectomy and the bowel and bladder effects of radiotherapy, and are prepared to accept a small retreatment risk.
-
Recurrence after radiotherapy
Selected men with MRI-visible in-field recurrence after prior radiotherapy — salvage focal therapy avoids morbid salvage prostatectomy.
-
Not a candidate: high-risk or metastatic
Gleason 8–10, extensive bilateral disease, seminal-vesicle invasion or nodal or bony spread — these need radical or systemic treatment, not focal.
Modalities
HIFU is not the only option.
What each modality on the UK table actually involves — and which suits which tumour location.
-
HIFU — Sonablate or Focal One
High-intensity focused ultrasound delivered transrectally. NICE IPG756 (2023) supports standard use in appropriate patients. The commonest UK focal modality.
-
Focal cryotherapy
Argon-gas probes freeze the tumour under ultrasound guidance. NICE IPG423. Well suited to anterior tumours and salvage after radiotherapy.
-
Irreversible electroporation (NanoKnife)
Short electrical pulses open cell membranes without heat — NICE IPG616. Useful for tumours close to the urethra or neurovascular bundles.
-
Focal brachytherapy (LDR seeds)
Radioactive seeds implanted only into the tumour-bearing zone. Delivered at a small number of UK specialist centres.
-
TULSA — transurethral ablation
MRI-guided ultrasound delivered through the urethra rather than the rectum. A newer modality, offered at a handful of UK centres.
-
Vascular-targeted photodynamic therapy
Padeliporfin (WST-11) activated by laser light — historically CE-marked for low-risk disease. Availability in the UK is now limited.
-
Radical prostatectomy — for context
Complete removal of the prostate. Higher continence and potency risk than focal, but the definitive answer for extensive or high-risk disease.
-
External-beam radiotherapy — for context
Whole-gland treatment over 4–20 sessions. An alternative to prostatectomy; bowel, bladder and sexual side-effects differ from focal.
Our vetted UK network
A small panel of focal-therapy urologists, we picked them.
Consultant urologists at NICE-approved centres across London and beyond. Not listed publicly — introductions are made privately, once we understand your MRI and biopsy.
Selection criteria
How we choose every focal-therapy urologist in our network.
-
Consultant urologists at NICE-approved focal-therapy centres
-
Multiparametric MRI reported by a specialist uroradiologist
-
Transperineal template mapping biopsy, not TRUS-only
-
Multidisciplinary review before every focal case — surgery and radiotherapy on the table
Safety and recovery
What to expect afterwards — honestly.
Focal therapy is a well-tolerated day-case or overnight procedure. The trade-off is not risk versus safety — it is a small retreatment risk in return for preserving continence and potency.
-
Continence usually preserved
Over 90% of men remain pad-free after focal therapy — the sphincter and most of the prostate are left alone. The risk is much lower than after prostatectomy.
-
Erectile function usually preserved
When bilateral nerve-sparing is possible, over 75% of men who were potent before remain potent after. Focal therapy is the most nerve-preserving of the active treatments.
-
Catheter for 5–14 days
A urethral catheter is standard for the first week or two, depending on modality. Retention after removal happens in 5–10% and is usually short-lived.
-
Urinary tract infection
A course of antibiotics is given around the procedure. Infection is uncommon but any fever or spreading redness needs same-day medical review.
-
Urethral stricture
2–5% of men develop a narrowing of the urethra that needs a small procedure to open. It is treatable and does not undo the cancer treatment.
-
Rectal fistula is rare
A connection between the rectum and urinary tract is a serious complication of any prostate treatment. With modern focal therapy it happens in well under 1%.
-
In-field recurrence 15–25% at 5 years
Some tumour will return in the treated zone in roughly one in five men. Repeat focal therapy works in 30–40%; the rest go to salvage prostatectomy or radiotherapy.
-
Mandatory 12-month biopsy
A repeat template mapping biopsy at one year is not optional — it is the only reliable way to catch residual disease early, while salvage options are still simple.
-
Red flags
Fever, heavy bleeding, inability to pass urine after catheter removal, or new bowel symptoms need same-day contact with the clinic or A&E.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever modality was used, the note the urologist sends you keeps to the same shape.
A quiet reminder
Focal-therapy language is technical — we translate it into what it means for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis and modality chosen
Your Gleason grade, PSA, MRI PI-RADS score, tumour location, and which focal modality — HIFU, cryotherapy, IRE or other — was used.
- 02 Technique
Ablation zone and margins
The ablation template — which sextants were treated, how large a margin was taken around the MRI lesion, and how the neurovascular bundles were protected.
- 03 Findings
Intra-operative findings
Any technical difficulties, urethral cooling used, catheter type and duration, and whether the ablation covered the intended volume.
- 04 Impression
Follow-up schedule and PSA nadir target
Read this first: your PSA and MRI follow-up dates, the mandatory 12-month biopsy, and the salvage options if the treatment does not work.
Recognised by major UK insurers
Cover for focal therapy varies by insurer and by modality — usually funded when NICE-approved and clinically indicated. We confirm cover before booking, and flag any exclusions in writing.
Frequently asked
Everything we get asked about focal therapy for prostate cancer.
Straight answers on eligibility, modality choice, cost, NHS availability and what happens if the cancer comes back.
-
What is focal therapy for prostate cancer?
Focal therapy is tissue-preserving ablation of the visible tumour only — the surrounding prostate, urethra, sphincter and neurovascular bundles are left in place. It sits between active surveillance and radical treatment (prostatectomy or radiotherapy) and aims to control cancer while preserving continence and potency.
-
Am I a candidate for focal therapy?
The standard candidate has MRI-visible Gleason 3+4=7 (Grade Group 2), unilateral or unifocal disease, PSA under 20, and a life expectancy over 10 years. Some select 4+3=7 cases and some post-radiotherapy recurrences also qualify. A multiparametric MRI and a transperineal template mapping biopsy are essential to confirm the disease is focal.
-
HIFU, cryotherapy or IRE — which is best?
The best modality depends on tumour location, not brand loyalty. HIFU (NICE IPG756) is the commonest UK option and suits mid-gland and posterior tumours. Cryotherapy (IPG423) is well suited to anterior lesions and salvage after radiotherapy. IRE / NanoKnife (IPG616) is useful for tumours close to the urethra or nerves. A good focal-therapy urologist can offer more than one.
-
How much does focal therapy cost privately in the UK?
Roughly £15,000–£25,000 for HIFU, £12,000–£20,000 for cryotherapy, £15,000–£25,000 for IRE, and £12,000–£20,000 for focal brachytherapy. Prices include the procedure, anaesthetic, catheter and early follow-up. Multiparametric MRI and mapping biopsy add £2,500–£4,500. We confirm a firm figure within one working day.
-
Is focal therapy available on the NHS?
Yes, at a growing number of NICE-approved centres including UCLH, Imperial, the Royal Marsden and others. NHS provision is expanding but variable — waiting times and eligibility differ by trust. Private treatment can shorten the wait or add modalities not offered locally.
-
How long is recovery?
Most men are home the same day or the next morning, with a urethral catheter for 5–14 days depending on modality. Office work resumes in 1–2 weeks; heavy exercise waits 2–4 weeks. Continence returns quickly in over 90% of men; erectile function recovers over 3–6 months.
-
What if the cancer comes back after focal therapy?
In-field recurrence happens in roughly 15–25% of men at 5 years. Repeat focal therapy is possible in 30–40% of these; the remainder can still have salvage radical prostatectomy or radiotherapy with acceptable outcomes. This is the trade-off focal therapy asks you to accept: a small retreatment risk in return for keeping continence and potency now.
-
How is focal therapy followed up?
PSA and multiparametric MRI at 6 and 12 months, then annually. A repeat transperineal template mapping biopsy at 12 months is mandatory — it is the only reliable way to catch residual disease early, before salvage becomes harder.
-
Is focal therapy recommended by NICE?
NICE has issued interventional procedure guidance supporting focal HIFU (IPG756, 2023) for standard use in appropriate patients, and permits focal cryotherapy (IPG423) and irreversible electroporation (IPG616) under standard arrangements with consent and audit. BAUS endorses a specialist-centre pathway for all focal modalities.
Related tests
Looking for something else?
-
Multiparametric prostate MRI
The imaging that makes focal therapy possible.
Learn more -
Transperineal mapping biopsy
The biopsy that confirms disease is truly focal.
Learn more -
PSA and prostate blood tests
Baseline and follow-up prostate blood work.
Learn more -
All tests and procedures
Every test and procedure we arrange.
Learn more