Ultrasound is the cornerstone for prostatic imaging and covers diagnostics, therapy monitoring, and follow-up. In the aspect of focal therapy, accurate prostate cancer localization is mandatory. Contrast-enhanced ultrasound (CEUS) is a promising imaging technique which has shown to greatly increase the chances to find prostate cancer in biopsies. At the moment, CEUS is only performed in expert centers because of difficult interpretation and steep learning curves. CEUS quantification techniques can make reliable and objective interpretation, with a high sensitivity, possible outside of expert centers. Focal therapy and active surveillance are increasingly used, but require to be supported by proper imaging techniques. CEUS seems a promising technique for real-time monitoring and follow-up of focal therapy treatment. In the near future, the use of targeted contrast agents will be a major breakthrough in the combat against prostate cancer. They show promising results regarding better visualization and longer lasting contrast enhancement of prostate cancer in in-vitro as well as in in-vivo animal experiments.