Prostate Cancer · University Urology, PC
Focal Therapy for Prostate Cancer:
HIFU & NanoKnife (IRE)
Precisely targeted, minimally invasive treatments designed to destroy prostate cancer while protecting the tissues that matter most — urinary control, sexual function, and quality of life.
What is Focal Therapy?
Treating the Cancer. Sparing the Rest.
Traditional whole-gland treatments for prostate cancer — radical prostatectomy and radiation — treat the entire prostate. They are highly effective, but carry meaningful risks of long-term side effects, including urinary incontinence and erectile dysfunction.
Focal therapy takes a different approach. Using precise imaging and real-time guidance, we target and destroy only the cancerous tissue — the index lesion — while leaving healthy prostate tissue, nerves, and surrounding structures intact.
University Urology is the only practice in East Tennessee offering both primary and salvage focal therapy. All focal therapy cases are performed by Dr. James M. Bienvenu, a fellowship-trained urologic oncologist, at the University of Tennessee Medical Center in Knoxville.
University Urology Focal Therapy Program
East Tennessee's Only HIFU & NanoKnife Center
All procedures are performed at University of Tennessee Medical Center in Knoxville — with dedicated focal therapy procedure days and on-site surgical support.
Our program serves patients from across East Tennessee, Kentucky, Southwest Virginia, Western North Carolina, and Northern Georgia.
Technologies
in the Region
Day
Procedure
Our Focal Therapy Options
HIFU & NanoKnife: Two Precision Technologies
We offer the two most established focal therapy platforms for prostate cancer. The right choice depends on tumor characteristics, prostate size, tumor location, and your individual goals — Dr. Bienvenu will determine which is most appropriate at your consultation.
HIFU — High-Intensity Focused Ultrasound
Sonablate® · FDA-cleared for prostate tissue ablation (2015)
HIFU uses precisely focused ultrasound waves to heat and destroy targeted prostate tissue. The energy converges at a single focal point, raising temperatures high enough to destroy cancer cells while leaving surrounding tissue unaffected.
The Sonablate® system monitors real-time tissue changes throughout treatment and provides continuous ablation feedback, allowing Dr. Bienvenu to confirm adequate tissue destruction before concluding the case.
NanoKnife — Irreversible Electroporation (IRE)
AngioDynamics NanoKnife® · Non-thermal ablation technology
NanoKnife uses precisely delivered electrical pulses to permanently disrupt cancer cell membranes — irreversible electroporation (IRE). Unlike HIFU, NanoKnife is a non-thermal technology: it destroys tissue without heat, which is critical for tumors near sensitive structures.
Because NanoKnife does not rely on heat, it preserves the structural integrity of adjacent vessels, nerves, and ducts — a meaningful advantage when tumor location makes thermal ablation riskier.
Patient Selection
Who Is — and Who Is Not — a Candidate for Focal Therapy?
Focal therapy is not the right choice for every patient with prostate cancer. Proper patient selection is the single most important factor in achieving good outcomes. The criteria below are a general guide — your complete situation will be reviewed at your consultation.
✓ Likely a Good Candidate
- Localized, low- to intermediate-risk disease — Gleason 3+3=6 or 3+4=7 (Grade Group 1–2)
- Well-defined, discrete tumor on multiparametric MRI (mpMRI) with PI-RADS ≥ 3
- Generally PSA under 10 ng/mL without high-risk biochemical features
- Clinical stage T1c or T2a — no extraprostatic extension
- Prostate volume compatible with device delivery (generally <60–70 cc for HIFU; NanoKnife is less size-dependent)
- No lymph node or distant metastases on staging imaging
- Strong desire to preserve urinary and sexual function with an acceptable oncologic tradeoff
- Currently on active surveillance seeking a step-up short of radical therapy
- Select intermediate-risk patients (Gleason 4+3=7; Grade Group 3) following multidisciplinary review
✕ Generally NOT a Good Candidate
- High-risk or very high-risk disease — Gleason ≥ 8 (Grade Group 4–5); whole-gland treatment is typically indicated
- Multifocal, diffuse cancer without a dominant index lesion
- Extraprostatic extension, seminal vesicle invasion, or lymph node involvement (≥ T3 disease)
- Distant metastases — focal therapy treats local disease only
- Very large prostate (>80 cc) without prior volume reduction, particularly for HIFU
- Prior rectal surgery or severe rectal pathology (relevant for transrectal HIFU delivery)
- Inability to tolerate anesthesia or significant surgical comorbidities
- Unwillingness to commit to active PSA surveillance and possible re-treatment after focal therapy
🔄 Salvage Focal Therapy: A Second Chance After Radiation
Both HIFU and NanoKnife can be used as salvage focal therapy for men with recurrent prostate cancer following prior radiation — including external beam radiation (EBRT) and brachytherapy. If your PSA is rising after radiation, focal therapy may provide effective local disease control with a more favorable side effect profile than salvage surgery or reirradiation. Outside biopsy pathology and prior imaging are required before scheduling a salvage consultation.
Before Your Appointment
What We Need to Evaluate You for Focal Therapy
To make the most of your consultation, please ensure the following are available before or at the time of your visit. Many referring offices can assist with transferring records.
Prostate Biopsy Pathology Report
A recent biopsy with Gleason grading is required. Transperineal biopsy is our preferred technique and can be arranged at University Urology if you have not yet had one. Molecular testing results (Oncotype DX, Decipher, Prolaris) are helpful when available.
Multiparametric MRI (mpMRI) of the Prostate
A high-quality mpMRI with PI-RADS scoring is essential for focal therapy planning. Please bring the imaging disc or arrange a transfer. If no MRI has been performed, we can coordinate this prior to your consultation.
Recent PSA Lab Values
PSA trend over time is more informative than a single reading. Please bring any available PSA history, including post-biopsy values.
Prior Treatment Records (Salvage Cases)
If you have received prior radiation or other prostate treatments, please obtain those records including radiation planning documents, treatment summaries, and all subsequent PSA values.
Staging Imaging (If Obtained)
Bone scan, CT, or PSMA PET results and images — if ordered by your referring provider — should be included in your records transfer.
Your Physician
Focal Therapy at University Urology
All focal therapy procedures are performed by Dr. James M. Bienvenu at the University of Tennessee Medical Center in Knoxville — the only physician in East Tennessee offering both HIFU and NanoKnife for prostate cancer.
Dr. James M. Bienvenu, MD
Fellowship-Trained Urologic Oncologist · University of Tennessee Medical Center, Knoxville
Dr. Bienvenu specializes in advanced urologic oncology including focal therapy (HIFU and NanoKnife), radical cystectomy, RPLND, caval thrombectomy, and robotic surgery. He is recognized among Newsweek's America's Best Prostate Cancer Surgeons (2024). All focal therapy cases are performed at UTMC with dedicated procedure days available.
View Dr. Bienvenu's Full Profile →Why University Urology
Comprehensive Prostate Cancer Care — All in One Practice
Focal therapy is one component of a full prostate cancer program. If your disease requires a different approach — or if focal therapy is followed by additional treatment — everything is available at UTMC.
Only Regional HIFU & NanoKnife Center
The only practice in East Tennessee offering both technologies, performed at UTMC with dedicated procedure days.
On-Site Transperineal Biopsy
If you need a biopsy before your focal therapy evaluation, we offer transperineal prostate biopsy at UTMC — the safest and most accurate technique available.
Advanced Imaging Integration
MRI/ultrasound fusion capabilities and PSMA PET coordination for comprehensive staging and treatment planning.
Multidisciplinary Cancer Team
We coordinate closely with medical and radiation oncology partners to ensure your treatment plan is complete before and after focal therapy.
Salvage & Recurrent Disease
We evaluate and treat patients with rising PSA after prior radiation or other prostate treatments — a complex area where few practices have meaningful experience.
Insurance Navigation Support
Our team manages prior authorization, appeals, and coverage questions so you can focus on making the best treatment decision — not paperwork.
Frequently Asked Questions
Common Questions About Focal Therapy
Ready to Explore Focal Therapy?
Schedule a consultation with Dr. Bienvenu at UT Medical Center in Knoxville. Bring your pathology, MRI, and PSA history — and we'll give you a straight answer about whether focal therapy is right for you.