[Which Focal Therapy for Whom and When?]

Focal therapy (FT) is used to selectively ablate tumor-bearing regions while preserving as much healthy prostatic tissue as possible. This approach seeks to maintain the functional advantages over radical treatment options - such as radical prostatectomy or radiation therapy - without significantly compromising local tumor control. At present, FT is offered primarily to carefully selected patients with low-risk or early intermediate-risk prostate cancer who do not wish to undergo active surveillance or are considered unsuitable candidates for this approach. Reliable patient selection requires multiparametric magnetic resonance imaging, targeted and systematic biopsies, and a precise assessment of tumor location, tumor volume, and prostatic anatomy.FT procedures can be divided into thermal (e.g., high-intensity focused ultrasound (HIFU) or cryotherapy) and non-thermal ablation methods (vascular-targeted photo-dynamic therapy (VTP) or irreversible electroporation (IRE)). These procedures differ in terms of their mechanism of action, technical implementation, and suitability for specific tumor locations. Consequently, the choice of procedure must be made on a case-by-case basis, taking into account the anatomical characteristics and the physical limitations of the respective technology.The aim of this review is to present the currently available focal therapy techniques with regard to their indications, technical characteristics, limitations, and suitability for different tumor locations. Particular emphasis is placed on identifying the most appropriate treatment modality for a given tumor location. Precise diagnostic evaluation, consideration of tumor location, and the selection of an appropriate ablation technique are essential determinants of treatment success. Given the varying strengths and limitations of the available technologies, centers should offer several complementary techniques to enable individualized treatment tailored to the specific tumor.