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Abstract Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. (3) The introduction of PSA screening has led to stage, and risk migration towards diagnosis of less aggressive PCa. The available evidence from randomized controlled trials demonstrates that there is little to no difference between surveillance vs radical therapies in terms of overall and cancer-specific survival after a median of 10 years of follow-up.(4, 5) Radical therapies is associated with high rates of erectile dysfunction seen in 24-90%, urinary incontinence in 2-72% and rectal toxicity in 2-15% with detrimental impact on quality of life.(6-9) On the other hand, active surveillance is challenged by non-standardization between institution and psychological impact on patients. Focal therapy techniques have been proposed as an alternative minimally invasive technique that aim to destroy the tumor while preserving the surrounding non-cancerous tissue. The goal is to maintain disease control at acceptable levels, while preserving erectile, urinary, and rectal function by minimizing damage to the neurovascular bundles, external sphincter, bladder neck and rectum. (16-21) In this study, we sought to evaluate the oncological efficacy and safety of MRI guided focal laser ablation of localized low and intermediate risk PCa. 18 consecutive subjects were included who had gland confined low or intermediate risk prostate cancers diagnosed by in bore MRI targeted biopsy. All patients had pre-procedure workup including serum PSA, creatinine, CBC and coagulation profile in addition to multiparametric MRI and MRI guided biopsies. Transrectal |