High-intensity focused ultrasound has come a long way since its early days as a whole-gland treatment for prostate cancer. Back then, it got the job done—but often at the cost of urinary continence and erectile function. The field has since pivoted to focal therapy, a more selective approach that ablates only clinically significant cancer while preserving surrounding healthy structures.

Yet focal therapy introduced its own set of challenges. The prostate doesn’t stay still during treatment—it swells from thermal injury and shifts position, making it difficult to deliver energy precisely to a small target.

A simple technical innovation—transrectal prostate compression—is now helping to solve that problem. By injecting additional water into the HIFU probe's balloon to apply gentle pressure on the prostate, clinicians can reduce intraoperative swelling and minimize target displacement. Compression also decreases blood flow within the prostate, mitigating the heat-sink effect that can otherwise cool the target area and compromise ablation.

The authors review clinical data from 240 patients treated with focal HIFU under compression, with a median follow-up of 48 months. Biochemical and pathological disease-free survival rates were 93.7% and 92.2% in low-risk patients, 88.5% and 91.6% in intermediate-risk patients, and 84.8% and 86.6% in high-risk patients. Across all risk groups, over 94% of patients avoided salvage surgery or radiotherapy during follow-up.

Safety outcomes were equally reassuring. Complication rates were low: urethral stricture in 2.9%, urinary tract infection in 2.1%, grade 1 incontinence in 1.3%, and zero cases of recto-urethral fistula.

The beauty of this technique lies in its simplicity. It requires no new equipment—only a modification of existing practice. For patients with localized prostate cancer, focal HIFU with intraoperative compression represents a promising balance between effective cancer control and preserved quality of life. As the authors conclude, this technical refinement deserves continued evaluation and broader adoption.

The work titled “Technical development in high-intensity focused ultrasound for localized prostate cancer: Intraoperative compression of the prostate” was published in UroPrecision (published on January 11, 2026).
DOI:10.1002/uro2.70039