Form:P-MRI Biopsy Follow-up v5.1


CDE IDCDE Description
* 421EDRN Participant ID (Go To: 2596)
* 2596Date of biopsy (MM/DD/YYYY) (Go To: 2176)
* 2176Visit 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)
* 423EDRN Protocol ID (Go To: 422)
* 422EDRN Site ID (Go To: 929)
* 929EDRN Staff ID of the person who collected the data: (Go To: 2705)
* 2705Indication for current prostate biopsy (Check all that apply.) (Go To: 844)
 
Permissible Values (value):Rising PSA (1)
 
 Elevated PSA (2)
 
 Abnormal DRE (3)
 
 Atypical small acinar proliferation (ASAP) (6)
 
 Family history (7)
 
 High grade PIN (8)
 
 Elevated PSA velocity (>0.4 ng/ml/yr) (22)
 
 Abnormal laboratory tests (26)
 
 Other, specify: (97) (Go To: 1578)
* 1578Indication for prostate biopsy, other specify: (Go To: 844)
* 844Date pathology report completed (MM/DD/YYYY): (Go To: 839)
   839ID number of local pathology report: (Go To: 4781)
* 4781Patholgy performed (Go To: 5653)
 
Permissible Values (value):Locally (1)
 
 Centrally (2)
 
 Unknown (99)
* 5653Type of biopsy (prostate) (Go To: 1595)
 
Permissible Values (value):Transrectal (1)
 
 Transperineal (2)
 
 Unknown (99)
* 1595Inflammation present? (Go To: 1598)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 1598Atrophy? (Go To: 2722)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 2722Prostate volume (cc): (Go To: 1586)
* 1586Presence of prostate adenocarcinoma: (Go To: 4541)
 
Permissible Values (value):Malignancy absent (1)
 
 Malignancy present (2) (Go To: 975)
* 975Prostate T-Stage, Clinical (Go To: 2179)
 
Permissible Values (value):T1a (4)
 
 T1b (5)
 
 T1c (6)
 
 T2a (8)
 
 T2b (9)
 
 T2c (10)
 
 T3a (12)
 
 T3b (13)
 
 T4 (14)
 
 TX (15)
* 2179Prostate N-Stage, Clinical: (Go To: 1694)
 
Permissible Values (value):NX (1)
 
 N0 (2)
 
 N1 (5)
* 1694Prostate M-Stage, Clinical : (Go To: 4541)
 
Permissible Values (value):MX (1)
 
 M0 (2)
 
 M1 (3)
 
 M1a (4)
 
 M1b (5)
 
 M1c (6)
* 4541Was a MRI/US Fusion Biopsy performed? (Go To: 980)
 
Permissible Values (value):No (0)
 
 Yes (1) (Go To: 4879)
 
 Unknown (99)
* 4879Type of MRI fusion biopsy (Go To: 980)
 
Permissible Values (value):Invivo UraNav (1)
 
 Artemis (2)
 
 Cognitive (3)
 
 In-gantry (4)
 
 Other, specify: (97) (Go To: 4880)
 
 Unknown (99)
* 4880Type of MRI fusion biopsy, other, specify (Go To: 980)
* 980Total number of cores taken: (Go To: 2872)
* 2872Total number of cores with cancer: (Go To: 2158)
 
Permissible Values (value):0 (0)
 
 1 (1)
 
 2 (2)
 
 3 (3)
 
 4 (4)
 
 5 (5)
 
 6 (6)
 
 7 (7)
 
 8 (8)
 
 9 (9)
 
 10 (10)
 
 11 (11)
 
 12 (12)
 
 13 (13)
 
 14 (14)
 
 15 (15)
 
 16 (16)
 
 17 (17)
 
 18 (18)
 
 19 (19)
 
 20 (20)
* 2158Number of specimens: (Go To: 2159)
* 2159Specimen line number or identifier (system-generated): (Go To: 2709)
* 2709Specimen identifier: (Go To: 4539)
* 4539Type of tissue targeting (Go To: 2160)
 
Permissible Values (value):None (0)
 
 MRI targeting (1)
 
 UM-specific targeting (2)
* 2160Tissue position (laterality): (Go To: 2213)
 
Permissible Values (value):Right (1)
 
 Left (2)
 
 Unilateral, side not specified (3)
 
 Bilateral (5)
 
 Other (95)
 
 Unknown (99)
* 2213Tissue position (regionality): (Go To: 2212)
 
Permissible Values (value):Apex (A) (1)
 
 Middle (M) (2)
 
 Base (B) (3)
 
 Unknown (99)
* 2212Tissue position (position within region): (Go To: 2211)
 
Permissible Values (value):Lateral (lat) (1)
 
 Medial (med) (2)
 
 Midline (3)
 
 Unknown (99)
* 2211Tissue position (zone): (Go To: 2712)
 
Permissible Values (value):Transition Zone (TZ) (1)
 
 Seminal vesicle (2)
 
 Anterior zone (3)
 
 Peripheral zone (4)
 
 Posterior zone (5)
 
 Unknown (99)
* 2712Specimen status (normal or abnormal): (Go To: 3158)
 
Permissible Values (value):Normal (1)
 
 Positive for malignancy (3) (Go To: 1589)
 
 Abnormal but negative for malignancy (4) (Go To: 984)
 
 Unknown (99)
* 1589Primary Gleason grade: (Go To: 1590)
* 1590Secondary Gleason grade: (Go To: 1696)
   1696Tertiary Gleason Pattern: (Go To: 1697)
* 1697Overall Gleason Score: (Go To: 2737)
* 2737Histological type (prostate): (Go To: 2713)
 
Permissible Values (value):Adenocarcinoma (4) (Go To: 2738)
 
 Sarcoma cell carcinoma (5) (Go To: 2713)
 
 Squamous cell carcinoma (6) (Go To: 2713)
 
 Transitional cell carcinoma (7) (Go To: 2713)
 
 Unknown (99) (Go To: 2713)
* 2738Histological subtype: (check all that apply) (Go To: 2713)
 
Permissible Values (value):Ductal (4)
 
 Mucinous (13)
 
 Neuroendocrine (15)
 
 Small cell carcinoma (19)
 
 Unknown (99)
* 2713Method used to record quantity of cancer in specimen: (Go To: 984)
 
Permissible Values (value):Percent cancer (1) (Go To: 2210)
 
 Length of cancer & length of specimen (2) (Go To: 2208)
 
 Unknown (99)
* 2210Percent of cancer in tissue: (Go To: 2838)
* 2838Notation for percent cancer value: (Go To: 984)
 
Permissible Values (value):< less than (1)
 
 No notation (10)
 
 Other, specify: (97) (Go To: 2839)
 
 Unknown (99)
* 2839Notation for percent cancer value (Other specify): (Go To: 984)
* 2208Length of cancer in tissue specimen (mm): (Go To: 2209)
* 2209Length of tissue specimen (mm): (Go To: 984)
* 984High grade prostatic intraepithelial neoplasia (PIN)? (Go To: 1596)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 1596Atypical small acinar proliferation (ASAP)? (Go To: 1597)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 1597Atypia/Suspicious? (Go To: 1591)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 1591Perineural invasion: (Go To: 4048)
 
Permissible Values (value):Present (1)
 
 Absent (2)
 
 Unknown (99)
* 4048Associated with intraductal carcinoma (ICD-P)? (Go To: 4969)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Uncertain (borderline case) (3)
 
 Unknown (99)
* 4969Presence of cribriform pattern? (Go To: 3158)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Uncertain (borderline case) (3)
 
 Unknown (99)
   3158Loop-specific comments: (Go To: 1097)
   1097Comments (do not include any participant identifiers) (Go To: End of Form)