| CDE ID | CDE Description | | * 1063 | Site Participant ID (Go To: 422) |
| * 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: 1322) |
| 1322 | Hispanic or Latino (Are you Hispanic or Latino?) (Go To: 1315) |
| | | Permissible Values (value): | No (0) |
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| 1315 | Race (What is your race? Check all that apply.) (Go To: 1294) |
| | | Permissible Values (value): | White (1) |
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| | | | Black or African-American (2) |
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| | | | American Indian or Alaska Native (3) |
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| | | | Native Hawaiian or other Pacific Islander (7) |
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| 1294 | Race (Other, specify) (Go To: 1567) |
| 1567 | Which race do you consider to be your primary racial background? (Go To: 1579) |
| | | Permissible Values (value): | White (1) |
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| | | | Black or African-American (2) |
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| | | | American Indian or Alaska Native (3) |
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| | | | Native Hawaiian or other Pacific Islander (7) |
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| 1579 | Primary racial background (Other, specify) (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: 1299) |
| | | Permissible Values (value): | No (0) |
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| 1299 | Currently smoke at least one cigarette a day? (Do you currently smoke cigarettes regularly, at least one a day?) (Go To: 1298) |
| | | Permissible Values (value): | No (0) |
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| 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: 1569) |
| | | Permissible Values (value): | No (0) |
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| 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: 2177) |
| 2177 | Have you ever been told by a doctor that you have any of the following genitourinary conditions? (Check all that apply.) (Go To: 2706) |
| | | Permissible Values (value): | [Males only] BPH (Benign prostatic hypertrophy) (1) |
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| | | | Hematuria (blood in the urine) (2) |
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| | | | [Males only] Prostatitis (an inflamed prostate) (3) |
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| | | | Urethritis (inflammation of the urethra) (6) |
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| | | | Other type of genitourinary tract infection (7) |
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| 2706 | Have you ever had any of the following procedures or problems? (Check all that apply.) (Go To: 1691) |
| | | Permissible Values (value): | [Males only] Transurethral resection of the prostate (TURP) (1) |
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| | | | [Males only] Transurethral incision of the prostate (TUIP) (2) |
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| | | | [Males only] Laser treatment for the prostate (interstitial laser or Niagra PVP) (3) |
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| | | | [Males only] Microwave or heat treatment for the prostate (TUNA or TUMT) (4) |
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| | | | [Males only] Balloon dilation (5) |
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| 1691 | Quality of life due to urinary symptoms: (Go To: 1572) |
| | | Permissible Values (value): | Delighted (1) |
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| 1572 | Have you ever taken any of the following medications or supplements for a prostate or genitourinary condition? (Check all that apply.) (Go To: 1573) |
| | | Permissible Values (value): | 5-alpha reductase inhibitors (eg Finasteride, Avodart or Proscar) (1) |
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| | | | Alpha-blockers (eg Doxazoin, Terazosin, Tamsulosin, others) (2) |
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| | | | Androgens (eg Testosterone, Androgel, others) (4) |
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| | | | Other medications for prostate related conditions, specify: (97) |
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| 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) |
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| | | | More than 1 month ago (2) |
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| 1575 | Total number of months taken (Go To: 1318) |
| 1318 | Previous prostate biopsy? (Go To: 1698) |
| | | Permissible Values (value): | No (0) |
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| 1698 | How many prostate biopsies have you previously had? (Go To: End of Form) |