| 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: 2788) |
| * 2788 | Age at selection: (Go To: 1322) |
| * 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: 4221) |
| | | 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: 4221) |
| * 4221 | Height (value): (Go To: 4222) |
| * 4222 | Height (unit): (Go To: 4223) |
| | | Permissible Values (value): | cm (centimeters) (1) |
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| * 4223 | Weight (value): (Go To: 4224) |
| * 4224 | Weight (unit): (Go To: 1300) |
| | | Permissible Values (value): | kg (kilograms) (1) |
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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: 2177) |
| | | 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: 1297) |
| | | 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: 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: 1715) |
| * 1715 | Total number of pack years 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) |
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| | | | Hematuria (blood in the urine) (2) |
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| | | | [Males only] Prostatitis (an inflamed prostate) (3) |
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| | | | Urinary tract infection (4) |
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| | | | Pyelonephritis (kidney infection) (5) |
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| | | | Urethritis (inflammation of the urethra) (6) |
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| | | | Other type of genitourinary tract infection (7) |
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| | | | Interstitial cystitis (9) |
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| * 2706 | Have you ever had any of the following procedures or problems? (Check all that apply.) (Go To: 1572) |
| | | Permissible Values (value): | [Males only] Transurethral resection of the prostate (TURP) (1) |
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| | | | [Males only] Transurethral incision of the prostate (TUIP) (2) |
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| | | | [Males only] Balloon dilation (5) |
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| | | | Surgery (open or endoscopic) for prostate (7) |
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| | | | Laser treatment for the prostate (e.g. interstitial laser, PVP or HOLEP) (8) |
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| | | | Microwave or heat treatment for the prostate (e.g. TUNA, TUMT, REZUM) (9) |
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| * 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) |
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| | | | Alpha-blockers (eg Doxazoin, Terazosin, Tamsulosin, others) (2) |
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| | | | Androgens (eg Testosterone, Androgel, others) (4) |
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| | | | Other medications for prostate related conditions, specify: (97) (Go To: 1573) |
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| | | | Refused (88) (Go To: 1318) |
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| | | | Unknown (99) (Go To: 1318) |
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| * 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) |
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| | | | More than 1 month ago (2) |
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| * 1575 | Total number of months taken (Go To: 1318) |
| * 1318 | Previous prostate biopsy? (Go To: 2650) |
| | | Permissible Values (value): | No (0) |
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| * 2650 | Participating in other studies? (Go To: 4779) |
| | | Permissible Values (value): | No (0) |
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| * 4779 | Have you had any prior MRIs? (Go To: 4966) |
| | | Permissible Values (value): | No (0) |
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| * 4966 | Has the participant had a bilateral hip replacement? (Go To: 1307) |
| | | Permissible Values (value): | No (0) |
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| * 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: 1568) |
| | | Permissible Values (value): | No (0) |
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| * 3142 | Number of cancers to record: (Go To: 3200) |
| | | Permissible Values (value): | 1 (1) |
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| 3200 | Line number or identifier (system-generated): (Go To: 1341) |
| * 1341 | Cancer type/location (Go To: 1305) |
| | | 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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| | | | Skin (melanoma, no basal or squamous) (18) |
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| * 1305 | Date of diagnosis - Year (Go To: 3158) |
| 3158 | Loop-specific comments: (Go To: 1568) |
| * 1568 | Have any of the participants living or deceased first or second-degree blood relatives been diagnosed with prostate cancer? (Go To: 1097) |
| | | Permissible Values (value): | No (0) |
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| * 1569 | How many of the participant´s living or deceased first or second-degree blood relatives have been diagnosed with prostate cancer? (Go To: 1097) |
| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |