At a Glance
Focal cryoablation (also called focal cryotherapy) is a minimally invasive prostate cancer treatment approved by NICE under IPG788 that uses precisely guided freezing to destroy a targeted cancer area while leaving the rest of the prostate intact. At The Focal Therapy Clinic, focal treatments aim to preserve the urinary continence and erectile function that matter most to our patients, with 97% of men maintaining continence and 90%+ retaining sexual function in our one-year audit of 265 patients.
Key takeaways
- Freeze-based focal therapy: cryo probes are inserted through the perineum under ultrasound guidance to create a controlled ice ball that destroys targeted cancer tissues.
- NICE approved (IPG788): focal cryotherapy is recognised by NICE as a treatment option for localised prostate cancer in selected men.
- Lower side effect profile: compared with whole-gland treatments, such as surgery or radiotherapy, focal approaches aim to reduce risk to continence and sexual function.
- Not suitable for everyone: careful MRI and biopsy assessment is required; treatment choice also depends on tumour location, prostate anatomy and the experience of the treating centre.
- HIFU and NanoKnife are alternatives: all three are focal therapies, but they use different energy types; suitability depends on individual cancer characteristics.
What is focal cryoablation?
Focal cryoablation is intended to treat only the area of the prostate containing the cancer being targeted, rather than removing or treating the whole gland. This is why it sits under the umbrella of focal therapy.
How cryoablation works
Imaging and biopsy mapping are used to confirm the tumour’s location. Thin needles (cryoprobes) are inserted into the prostate through the perineum (the skin between the scrotum and anus), under ultrasound guidance. A pressurised gas (argon) is used to freeze the targeted area, destroying tissue. Temperature probes and protective measures are used to help reduce the risk of damage to surrounding structures.
Patient information from Cancer Research UK similarly describes the use of needles through the perineum, ultrasound guidance, and a warming catheter to protect the urethra during freezing.
What can Focal Cryoablation treat?
Focal cryoablation is not suitable for every patient and is usually considered in specific clinical situations. The goal is not to “remove the prostate” or to eliminate all prostate tissue. Instead, it is to ablate a targeted area and, if successful, avoid or delay whole-gland treatments and their side effects for some men. Careful, individualised, expert assessment is required to determine whether it is appropriate.
Who may be considered for focal cryoablation
Focal cryoablation is not appropriate for everyone with prostate cancer. The decision depends on cancer characteristics, prostate anatomy, your general health, and your priorities.
Cancer stage and risk matter
In UK pathways, MRI is recommended as a first-line test for suspected localised prostate cancer, and biopsy strategy is guided by MRI findings.
Focal therapy is generally discussed in the context of localised disease, where there is a clearly defined area (lesion) and a realistic expectation that treatment can be targeted. Even then, prostate cancer can be multifocal, which is one reason why outcomes depend heavily on careful selection and follow-up.
Imaging and biopsy quality are important
High-quality MRI and well-planned biopsies are vital in deciding whether focal therapy is suitable for you. Candidates commonly need imaging and biopsy mapping to show where the cancer is, and how aggressive it appears. You should expect the team to review your MRI carefully and discuss whether the cancer is likely to be confined to a targetable area.
How cryoablation compares with HIFU and NanoKnife
Cryoablation, HIFU and irreversible electroporation (IRE, often referred to by the device name, NanoKnife) are all focal therapy approaches, but they all work and interact with tissues in different ways. Your anatomy, tumour location, tumour biology, and the experience of your surgeons and centre all matter, which is why every case should be individualised to your specific needs and profile.
| Treatment | Energy type | How it destroys tissue | Key idea |
|---|---|---|---|
| Focal cryoablation | Cold / freezing (cryo) | Needles placed through perineum, iceball forms, freezing targeted tissue, with temperature monitoring and protective steps | Freeze |
| HIFU | Focused ultrasound (thermal) | Probe delivers focused sound waves to heat and destroy the target tissue | Heat |
| NanoKnife (IRE) | Electrical pulses (non-thermal) | Needle electrodes placed through perineum, delivering short pulses that disrupt cell membranes, leading to cell death | Electric field |
Comparing patient experience and side effects
All focal treatments aim to treat the cancer while limiting damage to the rest of the prostate. This is different from surgery or radiotherapy, which usually treat or remove the whole gland.
For carefully selected men, focal therapy may offer lower risks of urinary leakage and sexual side effects than whole-gland treatment. However, outcomes vary. They depend on the cancer’s position, the size of the treatment area, previous urinary and sexual function, and the experience of the treating team.
Urinary and sexual function
Focal therapy aims to preserve urinary control and erections where possible. Many men have good urinary control after treatment, especially when only a small area of the prostate is treated.
Erectile function is more variable. It can be affected if the cancer is close to the nerves involved in erections, or if a larger treatment area is needed. Some men may also notice changes in ejaculation after treatment. These points should be discussed before deciding on treatment.
Recovery and future treatment options
Recovery after focal therapy is often quicker than after major surgery, although this varies between patients and treatment types. Some men return to normal activities within a short period, while others need longer.
Another potential advantage is flexibility. If cancer returns in the treated area, or if a new area develops elsewhere in the prostate, further treatment may be possible. This might include another focal treatment, surgery, radiotherapy, or monitoring, depending on the situation.
How treatment choice is made
Treatment decisions are made after careful review by experienced specialists. The team looks at where the cancer is, how visible it is on MRI, how close it is to important structures, and whether focal treatment is suitable at all.
For some men, HIFU may be appropriate. For others, NanoKnife may be considered. Cryoablation may also have a role in selected cases, depending on the tumour position and the clinical setting.
The important point is that treatment should be matched to the cancer, not chosen because one technology sounds newer or more advanced.
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What are the Benefits and Limitations of Focal Cryoablation?
Focal cryoablation can be useful in selected men with localised prostate cancer. It has been used for many years and is part of the wider focal therapy landscape.
Like all treatments, it has advantages and limitations. The decision should be made after proper imaging, biopsy review, and specialist discussion.
Advantages
Focal cryoablation is minimally invasive and targets a selected area of the prostate. It may help reduce the risk of urinary and sexual side effects compared with treating the whole gland, particularly in carefully selected patients.
It can also be considered in some men whose prostate cancer has returned after radiotherapy. In this setting, treatment planning needs particular care because previous radiotherapy can affect healing and side-effect risk.
Limitations and considerations
Cryoablation creates an iceball around the target area. This needs careful monitoring, especially when the cancer is close to the urethra, rectum, bladder neck, or nerves involved in erections.
Focal cryoablation also requires careful follow-up. Prostate cancer can be present in more than one area of the gland, so MRI, PSA monitoring, and sometimes repeat biopsy may be needed after treatment.
The evidence for focal cryoablation is encouraging in selected men, but long-term data and direct comparisons with other treatments are still developing.
Is focal cryoablation right for you?
Focal cryoablation is not suitable for every man with prostate cancer. It is usually considered when the cancer is localised, clearly visible, and can be targeted safely.
The right treatment depends on the cancer grade, MRI findings, biopsy results, prostate size, urinary symptoms, sexual function, and personal priorities.
How Focal Therapy Clinic helps you decide
The Focal Therapy Clinic reviews each case in detail before advising on treatment. MRI scans, biopsy results, PSA history, prostate anatomy, and patient priorities are all considered.
Some men may be suitable for focal therapy. Others may be better served by active surveillance, surgery, radiotherapy, or another approach. The aim is to give clear, balanced advice so that patients understand the realistic benefits and trade-offs of each option.
FAQs
References
European Association of Urology. (2026). EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer. Available at: https://uroweb.org/guidelines/prostate-cancer
National Institute for Health and Care Excellence. (2023). Focal therapy using high-intensity focused ultrasound for localised prostate cancer (HTG667). Available at: https://www.nice.org.uk/guidance/htg667
National Institute for Health and Care Excellence. (2023). Irreversible electroporation for treating prostate cancer (HTG688). Available at: https://www.nice.org.uk/guidance/htg688
National Institute for Health and Care Excellence. (2019). Prostate cancer: diagnosis and management (NG131, last updated 2021). Available at: https://www.nice.org.uk/guidance/ng131
Ślusarczyk, A., Gurwin, A., Barnaś, A., et al. (2025). Outcomes of Focal Therapy for Localized Prostate Cancer: A Systematic Review and Meta-analysis of Prospective Studies. European Urology Oncology, 8(6), 1653-1672.
Cancer Research UK. (n.d.). Cryotherapy for prostate cancer. Available at: https://www.cancerresearchuk.org/about-cancer/prostate-cancer/treatment/cryotherapy
Prostate Cancer UK. (n.d.). Cryotherapy. Available at: https://prostatecanceruk.org/prostate-information-and-support/treatments/cryotherapy
