Form:Canary: PASS Baseline Procedures v3.0


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: 4546)
 
Permissible Values (value):Normal (1)
 
 Abnormal, clearly suspicious for cancer (6)
 
 Unknown/refused (99)
* 4546Has the participant had a biomarker test performed? (Go To: 1698)
 
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: 3163)
   3163Loop-specific comments 2: (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)