Purpose of Review: The goal of this paper was to review the novel treatment modality of high-intensity transurethral directional ultrasound for prostate cancer. Recent Findings: Prostate cancer is a heterogeneous disease with some patients electing for active surveillance and focal therapies instead of definitive treatment with radical prostatectomy or radiation therapy. Prostate MRI has become a cornerstone of prostate cancer diagnosis, targeted biopsy, and treatment planning. Transurethral high-intensity directional ultrasound allows for MRI-guided ablation of the prostate gland with the ability to contour boundaries and spare critical structures, such as the neurovascular bundle and urinary sphincter. Although results are still emerging, this may offer patients a new option for focal therapy with a favorable side-effect profile. Summary: High-intensity transurethral directional ultrasound is an emerging treatment modality for both whole-gland and focal ablation with promising early results. Further research is needed to establish safety, tolerability, and long-term oncologic outcomes.