Prostate cancer ablation represents an emerging alternative in the treatment of prostate cancer by utilizing precision therapy to preserve function and limit side effects. Advances in multiparametric MRI and targeted biopsy have enabled accurate localization of clinically significant disease, facilitating image-guided focal treatment while minimizing morbidity. This chapter reviews the biophysical principles, clinical evidence, and evolving role of major ablative modalities—including cryoablation, high-intensity focused ultrasound (HIFU), transurethral ultrasound ablation (TULSA), irreversible electroporation (IRE), and laser ablation. Each technique employs distinct mechanisms—thermal or nonthermal—to achieve localized cytotoxicity while preserving neurovascular and sphincteric integrity. Early to mid-term data from prospective trials and registries demonstrate encouraging oncologic control and suggest good functional outcomes relative to radical prostatectomy or radiotherapy in well-selected patients with low- to intermediate-risk disease. The integration of MRI into all stages of focal therapy—patient selection, treatment planning, thermometry, and posttreatment surveillance—has been transformative, enabling real-time guidance and standardized evaluation of treatment response. Remaining challenges include long-term oncologic validation, procedural standardization, and incorporation of imaging and molecular biomarkers for improved patient stratification. Collectively, prostate ablation offers a minimally invasive bridge between active surveillance and definitive therapy, with the potential to redefine management of localized prostate cancer.