Patients with Gleason 3+4=7 represent one of the largest "grey areas" in the world of prostate cancer. For patients with Gleason 3+3=6, the medical community knows that active surveillance is the recommended course; for patients with Gleason 4+3=7, oncologists will almost always recommend some form of treatment (there could be some exceptions, for example, the very elderly). However, for patients with Gleason 3+4=7, whether a patient should choose treatment or may consider active surveillance depends upon confirmation of the pathological interpretation, other features of the cancer, and other factors related to a person's general health. In this video, medical oncologist Mark Scholz gives a survey of Gleason 3+4=7 and discusses some of the factors that determine whether a person with Gleason 3+4=7 can consider active surveillance, focal therapy, or whether they would be best served by radical treatment with radiation or surgery.

0:06 Can you explain the situation of a man who has been diagnosed with Gleason 3+4=7 prostate cancer?

2:42 How much Gleason 4 is too much for a Gleason 3+4=7 to consider active surveillance?

3:33 If a person with Gleason 3+4=7 is doing active surveillance, are you waiting to see if there is an increasing presence of Gleason 4 and then treating it?

4:57 What time frame do you use for follow-up MRIs?

5:05 What PSA do you expect to see with a Gleason 3+4=7 when there is a small amount of Gleason 4?

6:56 What is a safe active surveillance protocol for someone with Gleason 3+4=7?

7:46 How often should men with 3+4=7 be seeking a second opinion on their pathology report? Should they seek out genetic testing?

8:43 What level of risk do you think precludes someone with Gleason 3+4=7 from doing active surveillance as opposed to having treatment?

12:08 What is "focal therapy" and how is it relevant to Gleason 3+4=7 prostate cancer?

13:13 Are there cases of Gleason 3+4=7 that would not be good candidates for focal therapy? For example, if the cancer was on both sides of the prostate?

13:43 Is there a certain form of focal therapy that you prefer for your patients? For example, cryotherapy, HIFU, etc.

16:11 How many procedures do you think a doctor should have performed to suggest proficiency with any one kind of focal therapy?

17:27 How involved is focal therapy for a patient compared to surgery and radiation?

18:32 What are the side effects of focal therapy and how do they compare to radical treatment like surgery or radiation?

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