Form: (EXPIRED) Canary: PASS Baseline Procedures v2.0


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 423)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 1219)
* 1219Date of contact (MM/DD/YYYY): (Go To: 578)
* 578Age at specimen collection (Go To: 979)
* 979Date of digital rectal exam (DRE) (MM/DD/YYYY): (Go To: 976)
* 976Digital rectal exam results: (Go To: 2156)
 
Permissible Values (value):Normal (1)
 
 Abnormal, clearly suspicious for cancer (6) (Go To: 2173)
 
 Unknown/refused (99)
   2173Amount of induration/nodularity on digital rectal exam (DRE), if not normal: (Go To: 2156)
 
Permissible Values (value):Bilateral (5)
 
 Abnormal DRE but extent not specified (6)
 
 Left greater than right (7)
 
 Right greater than left (8)
* 2156Number of PSAs performed: (Go To: 1582)
* 1582Date of PSA: (Go To: 947)
* 947PSA (ng/ml) (Go To: 2502)
   2502PSA test used: (Go To: 4546)
 
Permissible Values (value):Bayer Immuno-1 PSA Test (1)
 
 Hybritech PSA Test (3)
 
 Roche Diagnostics Free PSA Test (4)
 
 Other, specify: (97) (Go To: 2503)
   2503PSA test used (Other, specify): (Go To: 4546)
* 4546Has the participant had a biomarker test performed? (Go To: 2495)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 3214)
 
 Unknown (99)
* 3214Number of subform loops to record 2: (Go To: 3201)
 
Permissible Values (value):1 (1)
 
 2 (2)
 
 3 (3)
 
 4 (4)
 
 5 (5)
 
 6 (6)
 
 7 (7)
 
 8 (8)
 
 9 (9)
 
 10 (10)
* 3201Line number or identifier 2 (system-generated): (Go To: 4547)
* 4547Prostate biomarker test name: (Go To: 4548)
 
Permissible Values (value):4Kscore (1)
 
 ConfirmMDx (2)
 
 Decipher (3)
 
 Oncotype DX for Prostate Cancer (GPS) (4)
 
 PCA3 (5)
 
 Prolaris (6)
 
 Prostate Health Index (PHI) (7)
 
 Select MDx (8)
 
 Other, specify: (97)
 
 Unknown (99)
   4548Biomarker test name (Other, specify): (Go To: 4551)
* 4551Date of biomarker test (MM/DD/YYYY) (Go To: 4549)
* 4549Biomarker test result: (Go To: 4552)
   4552Biomarker test result 2: (Go To: 4553)
   4553Biomarker test result 3: (Go To: 3163)
   3163Loop-specific comments 2: (Go To: 2495)
* 2495Cancer diagnosis method: (Go To: 2499)
 
Permissible Values (value):Diagnostic biopsy (1) (Go To: 1698)
 
 Suprapubic prostatectomy (3) (Go To: 2499)
 
 Transurethral resection of the prostate (TURP) (5) (Go To: 2499)
 
 Other, specify: (97) (Go To: 2496)
* 2496Cancer diagnosis method (Other, specify): (Go To: 3223)
   2499Number of specimens collected from secondary method: (Go To: 2498)
   2498Number of tissue specimens with cancer obtained from secondary method: (Go To: 2497)
   2497Per cent of cancer in tissue obtained from secondary method: (Go To: 2500)
   2500Primary Gleason grade obtained from secondary method: (Go To: 2501)
   2501Secondary Gleason grade obtained from secondary method. (Go To: 3223)
* 3223Date of procedure (MM/DD/YYYY): (Go To: 1698)
* 1698How many prostate biopsies have you previously had? (Go To: 5020)
* 5020Did participant have one or more negative biopsies prior to diagnostic biopsy? (Go To: 1097)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)