Form:	P-MRI Treatment Follow-up v5.0

CDE ID	CDE Description
* 421	EDRN Participant ID (Go To: 1219)
* 1219	Date of contact (MM/DD/YYYY): (Go To: 2176)
* 2176	Visit code (Go To: 423)
	Permissible Values (value): Y1V06 (20)
	Y1V12 (21)
	Y2V06 (22)
	Y2V12 (23)
	Y3V06 (24)
	Y3V12 (25)
	Y4V06 (26)
	Y4V12 (27)
	Y5V06 (28)
	Y5V12 (29)
* 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: 4648)
* 4648	Is the participant on active surveillance? (Go To: 2151)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1097)
	Unknown (99)
* 2151	Have you received any treatment for prostate cancer? (Go To: 3319)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3214)
	Unknown (99)
* 3214	Number of subform loops to record 2: (Go To: 3200)
	Permissible Values (value): 1 (1)
	2 (2)
	3 (3)
	4 (4)
	5 (5)
	6 (6)
	7 (7)
	8 (8)
	9 (9)
	10 (10)
* 3200	Line number or identifier (system-generated): (Go To: 2193)
* 2193	Treatment(s) received for prostate cancer: (Go To: 2478)
	Permissible Values (value): Chemotherapy (1)
	Radiation therapy (2) (Go To: 5555)
	Surgery (3)
	Hormone therapy (4)
	Other, specify: (97) (Go To: 2192)
* 2192	Treatment received for prostate cancer (Other, specify): (Go To: 2478)
* 5555	Fiducial marker inserted? (Go To: 2478)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 5556)
	Unknown (99)
* 5556	Date fiducial marker inserted (Go To: 2478)
* 2478	Treatment start date (MM/YYYY): (Go To: 2479)
* 2479	Treatment stop date (MM/YYYY): (Go To: 3158)
3158	Loop-specific comments: (Go To: 3319)
* 3319	Bone scan? (Go To: 3302)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3320)
	Unknown (99)
* 3320	Bone scan date (MM/YYYY): (Go To: 3322)
* 3322	Did bone scan detect recurrence? (Go To: 3302)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3321)
	Unknown (99)
* 3321	Date of bone scan verifying recurrence (MM/YYYY): (Go To: 3302)
* 3302	Imaging procedure performed? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 955)
	Unknown (99)
* 955	Date of imaging test (MM/DD/YYYY): (Go To: 3323)
* 3323	Did imaging procedure detect recurrence? (Go To: 1097)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 3324)
	Unknown (99)
* 3324	Date of imaging procedure that detected recurrence (MM/YYYY): (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)