Robotic transrectal high intensity focused ultrasound is an emerging, investigational, non invasive,local treatment for prostate cancer with 18 years of clinical experience during which approximately 40.000 treatments have been performed world wide, from those 2.800 in Munchen-Harlaching clinic (Germany), 1.100 in Samara Oncology Center (Russia).Treatment of prostate cancer needs to be individualized, based upon the patient's risk of progression,the likelihood of success and the risks involved with the therapy.Therefore attention of scientists is focused on the developed and implemented into clinical practice new effective, minimally invasive treatments for prostate cancer (PC), hormone-resistant prostate cancer (HRPC) and failure after external beam radiation therapy (EBRT) and radical prostatectomy (RPE).However, due to the fact that studies analysing the effectiveness of rHIFU-therapy for prostate cancer HRPC and failure after EBRT and RPE with a cohort of sufficient size and statistical power is few, the real work done.We like to show the current status of HIFU to be used as non invasive local therapy in curative or palliative approach for men with different stages of prostate cancer and how this additional therapeutic option fits into the multimodal long term therapy concept.This paper reflects the two centric experience in 17 years of clinical development and 3.900 personally performed cases, integrating significant publications as well as to give a 《look out》 to ongoing clinical research and development.