IntroductionThe treatment of localized prostate cancer seeks to minimize the impact on sexual function and urinary continence. In this respect, therapy with high-intensity focused ultrasound offers important results. We present our experience with this technique in 2 Spanish centers. Material and methodsWe conducted a retrospective review of 75 patients with localized prostate cancer treated with high-intensity focused ultrasound between March 2007 and July 2016. The oncological results and perioperative complications were assessed, as well as the impact on sexual function and continence. ResultsA total of 67 patients were analyzed. The mean follow-up was 7.2 years. The PSA nadir was 0.2ng/ml (0–3), 24 patients (35.5%) presented biochemical recurrence, and 18 underwent a further biopsy, with 10 cases (55.5%) presenting disease recurrence. The overall biochemical relapse-free survival at 5 and 8 years was 93.2 and 80.5%, respectively. The cancer-specific survival at 5 and 8 years was 96% in both cases. In the postoperative period, 50 patients (74.6%) were continent, 16 (23.9%) reported mild incontinence, and one (1.5%) reported moderate incontinence. The median International Index of Erectile Function-5 before and after the surgery was 17 (5–25) and 16 (2–23) points, respectively. Nine patients reported de novo erectile dysfunction (13.5%). ConclusionHigh-intensity focused ultrasound appears to be a safe alternative for the treatment of localized prostate cancer, especially for low-risk localized prostate cancer. In our experience, this technique offers advantages in preserving urinary continence, and the medium-term oncological results are encouraging. Given the natural progression of prostate cancer, long-term studies with a larger number of cases are needed to corroborate these results.