Robotic Focal HIFU - Focal One

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t the June 26 presentation, Dr. Ali Afshar, a leading urologic oncologist at Cedars-Sinai and Providence St. John’s in Los Angeles, joined the Prostate Forum to present an in-depth look at robotic focal therapy using Focal One HIFU (High-Intensity Focused Ultrasound). This robotic, image-guided system allows targeted treatment of prostate tumors. His talk explored how this image-guided, non-invasive treatment has fewer side effects than surgery or radiation and is improving quality of life for men with localized prostate cancer.

Why PSA Alone Isn’t Enough

Dr. Afshar began by explaining the role of PSA (Prostate-Specific Antigen) in prostate cancer screening. He emphasized that a single PSA value doesn’t tell the whole story. Trends over time, PSA velocity, free PSA levels, and imaging results all help build a clearer picture of prostate cancer risk. A rising PSA doesn’t always mean cancer, and not all cancers cause PSA to rise.

Diagnosing with Precision

To improve diagnosis accuracy, Dr. Afshar uses:

• MRI imaging to identify suspicious lesions

• Advanced urine tests to assess cancer risk

• Transperineal, MRI-fusion biopsies under sedation for more accurate and safer sampling

This approach improves detection of clinically significant prostate cancer while avoiding unnecessary biopsies in low-risk cases.

Understanding Risk and Treatment Choices

Dr. Afshar reviewed the standard risk categories:

• Low Risk: Gleason 3+3, PSA under 10

• Intermediate Risk: Gleason 3+4 or 4+3

• High Risk: Gleason 8+, PSA over 20

Treatment options vary by risk:

• Active Surveillance for most low-risk patients

• Surgery or radiation for high-risk and many intermediate-risk cases

• Focal Therapy offers a middle path for select patients

What Is Focal Therapy?

Focal therapy targets just the cancerous part of the prostate, sparing healthy tissue and reducing side effects. HIFU uses ultrasound energy to heat and destroy cancer cells with precision. The Focal One system fuses MRI and ultrasound images to guide treatment in real time, with no incisions and minimal downtime.

Benefits include:

• Outpatient procedure

• Low rates of incontinence and erectile dysfunction

• Cancer control comparable to traditional treatments in properly selected patients

• Does not eliminate future treatment options

Who’s a Good Candidate for Focal One HIFU?

Ideal patients include:

• Men with Gleason 7 (especially 4+3) prostate cancer

• MRI-visible lesions on one side of the prostate

• Prostate volume under 50 grams

• Good overall health and life expectancy

Focal therapy is also used for recurrence after radiation in select cases, and sometimes for patients unfit for surgery or extended radiation.

Follow-Up and Results

Patients are typically discharged the same day with a temporary catheter. PSA is monitored at 3-month intervals, with MRI and biopsy at 1 year. Long-term studies show:

• Erectile function preserved in ~80% of patients

• Incontinence rates under 2%

• Recurrence risk ~20–25%, often manageable

Importantly, focal therapy doesn’t “burn bridges.” If needed, patients can still have surgery, radiation, or repeat focal therapy later.

Final Takeaway

Focal therapy using Focal One HIFU is a game-changer for men seeking effective prostate cancer treatment with fewer life-altering side effects. It bridges the gap between active surveillance and aggressive intervention and is now offered at leading institutions including Cedars-Sinai, St. John’s, UCLA, and USC.

Watch the Full Presentation

This webinar was recorded and is available on our Video Library. Dr. Afshar’s previous presentation has reached thousands of viewers—don’t miss this valuable update.