Prostate cancer (PCa) care is an ever-evolving field. Research and technological developments continue to refine our definitions and management of this disease. Now, with a greater understanding of the natural history of PCa, the prevention of overtreatment has shaped a new era with the adoption of active surveillance (AS) and advancement of focal therapy (FT). Multiparametric magnetic resonance imaging (mpMRI) allows us to define, locate, and monitor cancers in a way never before possible. These capabilities combined with promising results from current prospective studies have changed the face of FT. This review presents the latest developments, current trends, and next steps in FT.