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Recent advances in ultrasonography (US) technology established modalities, such as Doppler-US, HistoScanning, contrast-enhanced ultrasonography (CEUS), elastography, and micro-ultrasound. The early results of these US modalities have been promising, although there are limitations including the need for specialized equipment, inconsistent results, lack of standardizations, and external validation. In this review, we identified studies evaluating multiparametric ultrasonography (mpUS), the combination of multiple US modalities, for prostate cancer (PCa) diagnosis. In the past 5 years, a growing number of studies have shown that use of mpUS resulted in high PCa and clinically significant prostate cancer (CSPCa) detection performance using radical prostatectomy histology as the reference standard. Recent studies have demonstrated the role mpUS in improving detection of CSPCa and guidance for prostate biopsy and therapy. Furthermore, some aspects including lower costs, real-time imaging, applicability for some patients who have contraindication for magnetic resonance imaging (MRI) and availability in the office setting are clear advantages of mpUS. Interobserver agreement of mpUS was overall low; however, this limitation can be improved using standardized and objective evaluation systems such as the machine learning model. Whether mpUS outperforms MRI is unclear. Multicenter randomized controlled trials directly comparing mpUS and multiparametric MRI are warranted.

Focal therapy (FT) has emerged as a potential treatment for localized prostate cancer (PCa) with encouraging functional outcomes. According to the compelling evidence based on meta-analyses and recent trials, erectile function (EF) is mostly retained at 6 and 12 months after FT when compared to baseline. These findings are consistent across different energy sources reported to date. However, overall, quality of life, including impotence, was not the endpoint for most studies. Additionally, impotency has not been consistently reported in most of the recent literature. Furthermore, confounding factors such as baseline potency and usage of phosphodiesterase 5 inhibitors (PDE5-I) were also frequently undisclosed. Long-term functional outcomes are awaited. To fully comprehend how FT affects EF, more extensive long-term randomized clinical trials using EF as a primary outcome are needed.

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