Form:	PCA3 Participant Questionnaire v2.0

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 422)
* 422	EDRN Site ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 1322)
* 1322	Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 1315	Race (What is your race? Check all that apply.) (Go To: 1567)
	Permissible Values (value): White (1)
	Black or African-American (2)
	American Indian or Alaska Native (3)
	Asian (4)
	Native Hawaiian or other Pacific Islander (7)
	Other, specify: (97) (Go To: 1294)
	Unknown/refused (99)
* 1294	Race (Other, specify) (Go To: 1567)
* 1567	Which race do you consider to be your primary racial background? (Go To: 1300)
	Permissible Values (value): White (1)
	Black or African-American (2)
	American Indian or Alaska Native (3)
	Asian (4)
	Native Hawaiian or other Pacific Islander (7)
	Other, specify: (97) (Go To: 1579)
	Unknown/refused (99)
* 1579	Primary racial background (Other, specify) (Go To: 1300)
* 1300	Ever smoke cigarettes regularly, at least one a day for a year or more? (Did you ever smoke cigarettes regularly, at least one a day for a year or more?) (Go To: 2177)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1299)
	Unknown/refused (9)
* 1299	Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 1297)
	Permissible Values (value): No (0) (Go To: 1298)
	Yes (1)
	Unknown/refused (9)
* 1298	Age quit smoking cigarettes? (How old were you when you permanently quit smoking cigarettes?) (Go To: 1297)
* 1297	Age first began smoking cigarettes regularly, at least one a day? (How old were you when you began smoking cigarettes regularly, at least one a day?) (Go To: 1325)
* 1325	Average number of cigarettes smoked per day? (During the time you have smoked, on average, how many cigarettes did you smoke per day?) (Go To: 1301)
* 1301	Total number of years smoked? (How many years total have you smoked?) (Go To: 2177)
* 2177	Have you ever been told by a doctor that you have any of the following genitourinary conditions? (Check all that apply.) (Go To: 2706)
	Permissible Values (value): [Males only] BPH (Benign prostatic hypertrophy) (1)
	Hematuria (blood in the urine) (2)
	[Males only] Prostatitis (an inflamed prostate) (3)
	Urinary tract infection (4)
	Urethritis (inflammation of the urethra) (6)
	Other type of genitourinary tract infection (7)
	Urinary stones (8)
	Interstitial cystitis (9)
	None (44)
	Unknown/refused (99)
* 2706	Have you ever had any of the following procedures or problems? (Check all that apply.) (Go To: End of Form)
	Permissible Values (value): [Males only] Transurethral resection of the prostate (TURP) (1)
	[Males only] Transurethral incision of the prostate (TUIP) (2)
	[Males only] Laser treatment for the prostate (interstitial laser or Niagra PVP) (3)
	[Males only] Microwave or heat treatment for the prostate (TUNA or TUMT) (4)
	Simple prostatectomy (10)
	Radical prostatectomy (11)
	None (44)
* 1572	Have you ever taken any of the following medications or supplements for a prostate or genitourinary condition? (Check all that apply.) (Go To: 1574)
	Permissible Values (value): 5-alpha reductase inhibitors (eg Finasteride, Avodart or Proscar) (1)
	Alpha-blockers (eg Doxazoin, Terazosin, Tamsulosin, others) (2)
	Anti-cholinergics (3)
	Androgens (eg Testosterone, Androgel, others) (4)
	Saw Palmetto (5)
	None (44) (Go To: 1307)
	Other medications for prostate related conditions, specify: (97) (Go To: 1573)
1573	Other prostate or genitourinary medications, specify: (Go To: 1574)
1574	When were the medications or supplements for your prostate or genitourinary condition last taken? (Go To: 1575)
	Permissible Values (value): Within the past month (1)
	More than 1 month ago (2)
1575	Total number of months taken (Go To: 1307)
* 1307	Ever had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor? (Have you ever had cancer [other than basal/squamous cell skin cancer] confirmed by a doctor?) (Go To: End of Form)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 1341	Cancer type/location (Go To: End of Form)
	Permissible Values (value): Bladder (1)
	Bone (2)
	Brain (3)
	Breast (4)
	Colon (6)
	Esophagus (7)
	Head & neck (mouth, nose, and throat) (8)
	Kidney (9)
	Liver (10)
	Leukemia (11)
	Lung (12)
	Lymphoma, including Hodgkins (13)
	Pancreas (15)
	Prostate (16)
	Rectum (17)
	Skin (melanoma, no basal or squamous) (18)
	Stomach (19)
	Thyroid (20)
	Testis (24)
	Hypopharynx (27)
	Larynx (28)
	Nasopharynx (29)
	Oropharynx (30)
	Oral Cavity (31)
	Other (95)
	Unknown/refused (99)
* 2732	Cancer type name: (Go To: 1333)
* 1333	Date of diagnosis (MM/YYYY): (Go To: 1302)
* 1302	Age at diagnosis (Go To: 2650)
* 2650	Participating in other studies? (Go To: End of Form)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
* 1568	Have any of the participants living or deceased first or second-degree blood relatives been diagnosed with prostate cancer? (Go To: 2194)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1569)
	Unknown/refused (9)
1569	How many of the participant´s living or deceased first or second-degree blood relatives have been diagnosed with prostate cancer? (Go To: 1570)
1570	How many of the participant´s living or deceased first or second-degree blood relatives have died of prostate cancer? (Go To: 2194)
* 2194	Have any of the participant's living or deceased second-degree blood relatives been diagnosed with prostate cancer? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 2195)
	Unknown/refused (9)
2195	How many of the participant´s living or deceased second-degree blood relatives have been diagnosed with prostate cancer? (Go To: 2654)
2654	How many of the participant´s second-degree blood relatives have died of prostate cancer? (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)