Form:	Prostate Reference Set Clinical v1.0

CDE ID	CDE Description
* 1063	Site Participant ID (Go To: 422)
* 422	EDRN Site ID (Go To: 423)
* 423	EDRN Protocol ID (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: 578)
578	Age at specimen collection (Go To: 1576)
1576	American Urological Association (AUA) symptom score: (Go To: 1699)
1699	Date of current prostate biopsy (MM/DD/YYYY): (Go To: 2705)
2705	Indication for current prostate biopsy (Check all that apply.) (Go To: 1578)
	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)
1578	Indication for prostate biopsy, other specify: (Go To: 2643)
2643	Reviewed by study personnel? (Go To: 979)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
979	Date of digital rectal exam (DRE) (MM/DD/YYYY): (Go To: 976)
976	Digital rectal exam results: (Go To: 2173)
	Permissible Values (value): Normal (1)
	Enlarged, benign (3)
	Enlarged/Asymmetry (4)
	Abnormal (firm/induration/nodularity), suspicious for cancer (5)
	Unknown/refused (99)
2173	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: 1587)
	Permissible Values (value): Malignancy absent (1)
	Malignancy present (2)
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: 2179)
	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)
2179	Prostate N-Stage, Clinical: (Go To: 1694)
	Permissible Values (value): NX (1)
	N0 (2)
	N1 (5)
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: End of Form)
	Permissible Values (value): No (0)
	Yes (1)