This study reports the efficacy of MRI-guided transurethral ultrasound ablation (TULSA) in treating localized prostate cancer (PCa) based on a single-center experience. Among 126 patients treated from 2020-2023, significant reductions in PSA levels, prostate volume, and PSA density were observed after one year. Of the 40 patients who underwent follow-up biopsies, 14 showed cancer recurrence, and 4 required additional treatments. The findings highlight TULSA’s promising potential for treating localized PCa with limited need for salvage treatments at the one-year mark.