| 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: 1302) |
| * 1302 | Age at diagnosis (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: 1292) |
| | | Permissible Values (value): | No (0) |
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| | | | [Males only] BPH (Benign prostatic hypertrophy) (1) (Go To: 2206) |
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| | | | [Males only] Prostatitis (an inflamed prostate) (3) (Go To: 2206) |
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| * 2206 | Prior treatment(s): (Go To: 1292) |
| | | Permissible Values (value): | Medication (1) |
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| | | | Other, specify: (97) (Go To: 2205) |
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| * 2205 | Prior treatment (Other, specify): (Go To: 1292) |
| * 1292 | Height [in inches] (What is your total current height in inches?) (Go To: 1295) |
| * 1295 | Weight [in pounds] (What is your current weight [in pounds]? (Go To: 1576) |
| * 1576 | American Urological Association (AUA) symptom score: (Go To: 1691) |
| * 1691 | Quality of life due to urinary symptoms: (Go To: 1322) |
| | | Permissible Values (value): | Delighted (0) |
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| * 1322 | Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315) |
| | | Permissible Values (value): | No (0) |
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| * 1315 | Race (What is your race? Check all that apply.) (Go To: 4049) |
| | | Permissible Values (value): | White (1) |
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| | | | Black or African-American (2) |
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| | | | American Indian or Alaska Native (3) |
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| | | | Native Hawaiian or other Pacific Islander (7) |
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| | | | Other, specify: (97) (Go To: 1294) |
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| * 1294 | Race (Other, specify) (Go To: 4049) |
| * 4049 | Marital status (SEER) (Go To: 1296) |
| | | Permissible Values (value): | Single (never married) (1) |
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| | | | Married (including common law) (2) |
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| | | | Marriage-like relationship (20) |
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| * 1296 | Highest level of education completed: (Go To: 1300) |
| | | Permissible Values (value): | Less than high school graduate (1) |
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| | | | High school graduate or completed GED (2) |
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| | | | Some college or technical school (3) |
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| * 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: 1328) |
| | | Permissible Values (value): | No (0) |
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| * 1299 | Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 1325) |
| | | Permissible Values (value): | No (0) (Go To: 1298) |
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| 1298 | Age quit smoking cigarettes? (How old were you when you permanently quit smoking cigarettes?) (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: 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: 1328) |
| * 1328 | Has participant ever had at least one drink of alcohol [beer, liquor, wine, or wine coolers] per month during a twelve-month period? (Have you ever had at least one drink of alcohol [beer, liquor, wine, or wine coolers] per month during a twelve-month period?) (Go To: 1349) |
| | | Permissible Values (value): | No (0) |
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| 1329 | On average, how many glasses of wine do you drink? Count a four-ounce glass of wine as one drink. (Go To: 1330) |
| | | Permissible Values (value): | None (4) |
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| 1330 | On average, how many glasses/cans of beer do you drink? Count a twelve-ounce can as one beer. (Go To: 1331) |
| | | Permissible Values (value): | None (4) |
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| 1331 | On average, how many shots of hard liquor or mixed drinks do you drink? Count one shot (1 1/2 ounces) or one mixed drink as one drink. (Go To: 1349) |
| | | Permissible Values (value): | None (4) |
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| * 1349 | Have any of the participant´s living and deceased first degree blood relatives been diagnosed with cancer [other than basal/squamous cell skin cancer]? (Have any of your living and deceased first degree blood relatives (biological parents, siblings, children) been diagnosed with cancer [other than basal/squamous cell skin cancer]? [Not including half-siblings, step-siblings, step-parents, or step-children]. (Go To: 1097) |
| | | Permissible Values (value): | No (0) |
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| * 3143 | Number of relative´s cancers to record: (Go To: 3202) |
| | | Permissible Values (value): | 1 (1) |
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| * 3202 | Line number or identifier 3 (system-generated): (Go To: 1351) |
| * 1351 | Relative type (mother, brother, etc) (Go To: 1311) |
| | | Permissible Values (value): | Brother (1) |
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| * 1311 | First primary cancer: (Go To: 1430) |
| | | Permissible Values (value): | Bladder (1) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Primary peritoneal cancer (46) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| | | | Other, specify: (97) (Go To: 1310) |
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| * 1310 | Cancer type/Location (Other, specify) (Go To: 1430) |
| 1430 | Relative´s age when diagnosed (Go To: 1317) |
| 1317 | Subsequent primary cancer(s): (Go To: 3272) |
| | | Permissible Values (value): | None (0) |
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| | | | Head & neck (mouth, nose, and throat) (8) |
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| | | | Lymphoma, including Hodgkins (13) |
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| | | | Primary peritoneal cancer (46) |
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| | | | Skin (melanoma, no basal or squamous) (18) |
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| 3272 | Loop-specific comments 5: (Go To: 1097) |
| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |