The use of minimally-invasive ablative therapies in localised prostate cancer offer potential for a middle ground between active surveillance and radical therapy. This article reviews the evidence for cryotherapy, high intensity focused ultrasound (HIFU) and photodynamic therapy in the treatment of localised prostate cancer. These ablative technologies can deliver a minimally invasive, day case treatment with effective early cancer control and low genitourinary morbidity. In addition, all have the ability to deliver focal therapy of only the malignant lesions within the prostate.