Form:	Prostate Reference Set v1.0

CDE ID	CDE Description
* 1063	Site Participant ID (Go To: 1319)
* 422	EDRN Site ID (Go To: 423)
423	EDRN Protocol ID (Go To: 1319)
* 1319	Date participant signed consent form (MM/DD/YYYY): (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: 1322)
1322	Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)
1315	Race (What is your race? Check all that apply.) (Go To: 1567)
	Permissible Values (value): White (1)
	Black or African-American (2)
	American Indian or Alaska Native (3)
	Asian (4)
	Native Hawaiian or other Pacific Islander (7)
	Other, specify: (97) (Go To: 1294)
	Unknown/refused (99)
1294	Race (Other, specify) (Go To: 1567)
1567	Which race do you consider to be your primary racial background? (Go To: 578)
	Permissible Values (value): White (1)
	Black or African-American (2)
	American Indian or Alaska Native (3)
	Asian (4)
	Native Hawaiian or other Pacific Islander (7)
	Other, specify: (97) (Go To: 1579)
	Unknown/refused (99)
1579	Primary racial background (Other, specify) (Go To: 578)
578	Age at specimen collection (Go To: 1300)
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: 1568)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1299)
	Unknown/refused (9)
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)
	Yes (1)
	Unknown/refused (9)
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: 1568)
1568	Have any of the participants living or deceased first or second-degree blood relatives been diagnosed with prostate cancer? (Go To: 1070)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1569)
	Unknown/refused (9)
1569	How many of the participant´s living or deceased first or second-degree blood relatives have been diagnosed with prostate cancer? (Go To: 1570)
1570	How many of the participant´s living or deceased first or second-degree blood relatives have died of prostate cancer? (Go To: 1070)
1070	Have you ever been told by a doctor that you have any of the following genitourinary conditions? (Check all that apply.) (Go To: 1571)
	Permissible Values (value): [Males only] BPH (Benign prostatic hypertrophy) (1)
	Hematuria (blood in the urine) (2)
	[Males only] Prostatitis (an inflamed prostate) (3)
	Urethritis (inflammation of the urethra) (6)
	Other type of genitourinary tract infection (7)
	None (44)
1571	Have you ever had any of the following procedures or problems? (Check all that apply.) (Go To: 1576)
	Permissible Values (value): [Males only] Transurethral resection of the prostate (TURP) (1)
	[Males only] Transurethral incision of the prostate (TUIP) (2)
	[Males only] Laser treatment for the prostate (interstitial laser or Niagra PVP) (3)
	[Males only] Microwave or heat treatment for the prostate (TUNA or TUMT) (4)
	[Males only] Balloon dilation (5)
	None (44)
1576	American Urological Association (AUA) symptom score: (Go To: 1691)
1691	Quality of life due to urinary symptoms: (Go To: 1572)
	Permissible Values (value): Delighted (1)
	Pleased (2)
	Mostly satisfied (3)
	Mixed (4)
	Mostly dissatisfied (5)
	Unhappy (6)
	Terrible (7)
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)
	Alpha-blockers (eg Doxazoin, Terazosin, Tamsulosin, others) (2)
	Anti-cholinergics (3)
	Androgens (eg Testosterone, Androgel, others) (4)
	Saw Palmetto (5)
	None (44) (Go To: 1318)
	Other medications for prostate related conditions, specify: (97) (Go To: 1573)
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)
	More than 1 month ago (2)
1575	Total number of months taken (Go To: 1318)
1318	Previous prostate biopsy? (Go To: 1699)
	Permissible Values (value): No (0)
	Yes (1) (Go To: 1698)
	Unknown/refused (9)
1698	How many prostate biopsies have you previously had? (Go To: 1699)
1699	Date of current prostate biopsy (MM/DD/YYYY): (Go To: 1577)
1577	Indication for current prostate biopsy (Check all that apply.) (Go To: 979)
	Permissible Values (value): Rising PSA (1)
	Elevated PSA (2)
	Abnormal DRE (3)
	Abnormal biopsy (4)
	Atypia (5)
	Atypical small acinar proliferation (ASAP) (6)
	Family history (7)
	High grade PIN (8)
	Other, specify: (97) (Go To: 1578)
1578	Indication for prostate biopsy, other specify: (Go To: 979)
979	Date of digital rectal exam (DRE) (MM/DD/YYYY): (Go To: 976)
976	Digital rectal exam results: (Go To: 1580)
	Permissible Values (value): Normal (1)
	Enlarged, benign (3)
	Enlarged/Asymmetry (4)
	Abnormal (firm/induration/nodularity), suspicious for cancer (5)
	Unknown/refused (99)
1580	Amount of induration/nodularity on digital rectal exam (DRE), if not normal: (Go To: 1582)
	Permissible Values (value): < 50% right (1)
	≥ 50% right (2)
	< 50% left (3)
	≥ 50% left (4)
	Bilateral (5)
	Abnormal DRE but extent not specified (6)
1582	Date of PSA: (Go To: 947)
947	PSA (ng/ml) (Go To: 1692)
1692	Prostate size (by TRUS): (Go To: 1581)
1581	Hypoechoic or suspicious foci seen? (Go To: 1583)
	Permissible Values (value): No (0)
	Yes (1)
1583	Number of cores biopsied on left: (Go To: 1584)
1584	Number of cores biopsied on right: (Go To: 1693)
1693	Number of other cores biopsied: (Go To: 1585)
1585	Types of other cores biopsied, specify: (Go To: 1586)
1586	Presence of prostate adenocarcinoma: (Go To: 984)
	Permissible Values (value): Malignancy absent (1)
	Malignancy present (2) (Go To: 1587)
1587	Number of positive cores involved on left: (Go To: 1588)
1588	Number of positive cores involved on right: (Go To: 1589)
1589	Primary Gleason grade: (Go To: 1590)
1590	Secondary Gleason grade: (Go To: 1696)
1696	Tertiary Gleason Pattern: (Go To: 1697)
1697	Overall Gleason Score: (Go To: 1591)
1591	Perineural invasion: (Go To: 1592)
	Permissible Values (value): Present (1)
	Absent (2)
1592	Percent of cancer in core with most cancer: (Go To: 1593)
1593	Length of core with most cancer (mm): (Go To: 975)
975	Prostate T-Stage, Clinical (Go To: 1594)
	Permissible Values (value): T0 (2)
	T1 (3)
	T1a (4)
	T1b (5)
	T1c (6)
	T2 (7)
	T2a (8)
	T2b (9)
	T2c (10)
	T3 (11)
	T3a (12)
	T3b (13)
	T4 (14)
	TX (15)
1594	Prostate N-Stage, Clinical (Go To: 1694)
	Permissible Values (value): NX (1)
	N0 (2)
	N1 (3)
1694	Prostate M-Stage, Clinical : (Go To: 984)
	Permissible Values (value): MX (1)
	M0 (2)
	M1 (3)
	M1a (4)
	M1b (5)
	M1c (6)
984	High grade prostatic intraepithelial neoplasia (PIN)? (Go To: 1595)
	Permissible Values (value): No (0)
	Yes (1)
1595	Inflammation present? (Go To: 1596)
	Permissible Values (value): No (0)
	Yes (1)
1596	Atypical small acinar proliferation (ASAP)? (Go To: 1597)
	Permissible Values (value): No (0)
	Yes (1)
1597	Atypia/Suspicious? (Go To: 1598)
	Permissible Values (value): No (0)
	Yes (1)
1598	Atrophy? (Go To: 1599)
	Permissible Values (value): No (0)
	Yes (1)
1599	Was blood collected after the DRE performed on the same day as specimen collection? (Go To: End of Form)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown/refused (9)