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Introduction Histological outcome of the targeted focal therapy is in principle confirmed by targeted needle biopsy from the treated area in clinical trial. Herein, we report a rare case in which the MFT was followed by RARP. Case presentation A 68‐year‐old man with PSA 9.6 ng/mL and PI‐RADS 4 lesion in the right transition zone on multi‐parametric MRI underwent MR/ultrasound fusion‐guided targeted biopsy, which revealed grade‐group 1 cancer. Targeted focal therapy with microwave ablation was performed, resulting in disappearance of the PI‐RADS 4 lesion at post‐operative 4 months. However, PSA rose to 11.5 ng/mL, and a new PI‐RADS 4 lesion, was identified in the left peripheral zone. RARP was performed to reveal new grade‐group 3 cancer, and no viable cells in the previously treated area with MFT. Conclusion RARP was safely performed even after MFT and proved the pathological complete response of microwave ablation.