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Originally published August 5, 2026
Last updated August 5, 2026
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Until recent years, the available treatments for prostate cancer resulted in side effects such as incontinence and erectile dysfunction after surgery or bowel inflammation after radiation.
When the prostate gland is removed during surgery, the urinary sphincters beside the gland typically are damaged or removed along with the organ. The nerves that control blood supply to the penis, which run along the back of the prostate, also may need to be removed during treatment.
“The biggest issues with prostate cancer treatment historically has been the trade-off between cancer control and side effects of the treatment,” says Jamal Nabhani, MD, a urologist with USC Urology, part of Keck Medicine of USC.
But as Nabhani discusses below, medical advances have enabled the preservation of the prostate gland, avoiding as much harm as possible to both the prostate and the structures beside it that affect urinary and erectile function.
Traditional treatments for prostate cancer have been either prostatectomy (removing part or all of the prostate gland) or radiation therapy.
Before more recent imaging technology, surgeons had little ability to map the exact location of the cancer in the prostate. They had to rely on PET and bone scans that were not accurate enough to pick up on very small areas of disease. As a result, surgeons had to treat the entire organ with broad surgeries and radiation fields, leading to side effects involving continence and erections.
Around the turn of the millennium, early iterations of focal therapy, such as high-intensity focused ultrasound (HIFU) and cryotherapy, treated the whole prostate. That led to significant complications such as fistulas between the urethra, bowel and bladder, resulting in incontinence, erectile dysfunction and infections.
“That was arguably a worse fate than radical therapy back in the early 2000s,” Nabhani says. Given the potential impact on patients, “focal therapy was not seen as a very viable option.”
With the advent of multiparametric MRI, surgeons now can identify and localize cancer within the prostate. Another advanced tool, the PSMA (prostate-specific membrane antigen) PET scan, uses a radioactive tracer to determine if cancer has spread outside the prostate and into the lymph nodes.
With more detailed and precise imaging tools, surgeons can identify the presence or absence of cancer in specific areas of the prostate and treat isolated lesions, while ruling out metastatic disease.
The result is that surgeons now have more treatment options and can make more informed decisions about which option, including targeted focal therapy, they should take. Another available option is aquablation, which uses a high-powered water jet to destroy prostate tissue without damaging the sphincter or neurovascular bundle that supplies erections.
“We can go after the lesion and leave the rest of the prostate alone, and treatment is less likely to cause significant side effects or complications,” Nabhani says. “More modern technologies led to a kind of reinvention of focal therapy.”
Nabhani has seen the benefits of these innovations particularly for younger patients who want to preserve their erectile and continence function for as long as possible.
Older patients also have benefited, he notes. In the past, older patients might not have been candidates for surgery, so they could have only radiation or long-term hormone therapy.
Now, younger and older patients have more treatment options. “Both groups benefit significantly from the advent of focal therapy,” Nabhani says.
Keck Medicine has been a leader in the adoption of advanced prostate-preservation techniques. “We’ve been on the cutting edge for the past 20 years,” Nabhani says, adding that a forward-thinking mindset at Keck Medicine will continue to lead to more care improvements in the future.
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