Form:Canary: TMA Participant Data v1.0


CDE IDCDE Description
* 1063Site Participant ID (Go To: 422)
* 422EDRN Site ID (Go To: 421)
* 421EDRN Participant ID (Go To: 1319)
* 1319Date participant signed consent form (MM/DD/YYYY): (Go To: 1429)
* 1429Year of birth (In what year were you born?) (Go To: 1322)
   1322Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown/refused (9)
   1315Race (What is your race? Check all that apply.) (Go To: 1837)
 
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 (95)
 
 Unknown/refused (99)
   1837Date of cancer diagnosis (MM/DD/YYYY): (Go To: 2646)
* 2646Neoadjuvant therapy(s) administered: (Go To: 774)
 
Permissible Values (value):Chemotherapy (1)
 
 Radiation therapy (2)
 
 Surgery (3)
 
 Hormone therapy (4)
 
 None (44)
 
 Other (95)
 
 Unknown (99)
* 774Date of surgery (MM/DD/YYYY): (Go To: 2605)
   2605Surgery type: (Go To: 2607)
 
Permissible Values (value):Laprascopic/Robotic (1)
 
 Open (2)
 
 Other (95)
   2607Nerve-sparing surgery? (Go To: 1589)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 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: 2628)
* 2628Seminal vesicle invasion? (Go To: 2629)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
   2629Seminal vesicle invasion site: (Go To: 2721)
 
Permissible Values (value):Right (1)
 
 Left (2)
 
 Both (3)
 
 Other (95)
 
 Unknown (99)
* 2721Extracapsular invasion? (Go To: 2720)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
   2720Extracapsular invasion site: (Go To: 2618)
 
Permissible Values (value):Right (1)
 
 Left (2)
 
 Both (3)
 
 Other (95)
 
 Unknown (99)
* 2618Margin status (presence of cancer at margin): (Go To: 2723)
 
Permissible Values (value):Positive (1)
 
 Negative (2)
 
 Uncertain (borderline case) (3)
 
 Unknown (99)
* 2723Lymph node status: (Go To: 2614)
 
Permissible Values (value):Positive (1)
 
 Negative (2)
 
 Uncertain (borderline case) (3)
 
 Unknown (99)
   2614Estimated tumor volume (cc): (Go To: 2210)
   2210Percent of cancer in tissue: (Go To: 2615)
   2615Tumor volume determination method: (Go To: 2608)
 
Permissible Values (value):Nickel method (1)
 
 Volume calculation by mass (2)
 
 Percent by eye (3)
 
 Greatest linear dimension (4)
 
 Other (95)
 
 Unknown (99)
   2722Prostate volume (cc): (Go To: 2610)
   2608Prostate weight (g): (Go To: 2722)
   2610Prostate T-Stage, Pathologic: (Go To: 2750)
 
Permissible Values (value):pT0 (2)
 
 pT1a (10)
 
 pT1b (11)
 
 pT1c (12)
 
 pT2 (13)
 
 pT2a (14)
 
 pT2b (15)
 
 pT3 (16)
 
 pT2c (27)
 
 pT3a (30)
 
 pT3b (31)
 
 pT3c (32)
 
 pT4 (34)
 
 pT4a (35)
   2750AJCC Manual edition: (Go To: 1878)
 
Permissible Values (value):Edition 1 went into effect 1978 (1)
 
 Edition 2 went into effect 1984 (2)
 
 Edition 3 went into effect 1993 (3)
 
 Edition 4 went into effect 1997 (4)
 
 Edition 5 went into effect 1998 (5)
 
 Edition 6 went into effect 2003 (6)
 
 Edition 7 went into effect 2010 (7)
 
 Unknown (99)
* 1878Date of last contact (MM/DD/YYYY): (Go To: 2719)
* 2719Adjuvant therapy administered: (Go To: 2638)
 
Permissible Values (value):Chemotherapy (1)
 
 Radiation therapy (2)
 
 Surgery (3)
 
 Hormone therapy (4)
 
 None (44)
 
 Other (95)
 
 Unknown (99)
   2638Recurrent cancer? (Go To: 1221)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown/refused (99)
   1221Recurrence date (MM/YYYY): (Go To: 2724)
* 2724Date of metastatic recurrence (MM/YYYY): (Go To: 2725)
* 2725Salvage therapy administered: (Go To: 1869)
 
Permissible Values (value):Chemotherapy (1)
 
 Radiation therapy (2)
 
 Surgery (3)
 
 Hormone therapy (4)
 
 None (44)
 
 Other (95)
 
 Unknown/refused (99)
* 1869Treatment start date (MM/DD/YYYY): (Go To: 1272)
   1272Living status: (Go To: 1336)
 
Permissible Values (value):Alive with disease (1)
 
 Alive with no evidence of disease (NED) (2)
 
 Dead (3)
 
 Unknown (99)
   1336Date of death (MM/DD/YYYY): (Go To: 2726)
   2726Death related to study outcome? (Go To: 3993)
 
Permissible Values (value):No (0)
 
 Yes (1)
 
 Unknown (99)
* 3993DMCC Eligibility (TMA study group) (Go To: 1097)
 
Permissible Values (value):Non-recurrent (1)
 
 Recurrent (<5 years) (2)
 
 Censored (3)
 
 Recurrent (>5 years) (4)
 
 Ineligible (5)
   1097Comments (do not include any participant identifiers) (Go To: 2749)
   2749Coordinating center data comments: (Go To: End of Form)