ID

10074

Descrizione

I1 Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Evaluation Form Adjuvant Radiation Therapy Plus Hormone Therapy Compared With Radiation Therapy Alone in Treating Patients With Stage II or Stage III Prostate Cancer NCT00023829 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E26ACF-75E7-25EA-E034-080020C9C0E0

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A4E26ACF-75E7-25EA-E034-080020C9C0E0

Keywords

versioni (2)
  1. 19/09/12 19/09/12 -
  2. 23/03/15 23/03/15 - Martin Dugas
Caricato su

23 marzo 2015

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy
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Prostate Cancer NCT00023829

Inglese

INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in the codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.

1 moduli  
  1. StudyEvent: I1 Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Evaluation Form
    1. INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in the codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
Header
Descrizione

Header

RTOG Study
Descrizione

RTOGStudy

Tipo di dati

text

Case #
Descrizione

Case#

Tipo di dati

text

Institution Name
Descrizione

InstitutionName

Tipo di dati

text

Institution No.
Descrizione

InstitutionNo.

Tipo di dati

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
Patient Name, Last
Descrizione

PatientName,Last

Tipo di dati

text

Patient Name, First
Descrizione

Patient Name, First

Tipo di dati

text

AMENDED DATA
Descrizione

AmendedData

Tipo di dati

text

COMMENTS
Descrizione

Comments

Tipo di dati

text

Signature
Descrizione

Signature

Tipo di dati

text

Date
Descrizione

Date

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Patient data
Descrizione

Patient data

PATIENT BIRTH DATE (2)
Descrizione

PatientBirthDate

Tipo di dati

date

Alias
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
PERFORMANCE STATUS (3)
Descrizione

PERFORMANCESTATUS

Tipo di dati

text

HAS PATIENT HAD ANOTHER MALIGNANCY (other than study site)
Descrizione

HASPATIENTHADANOTHERMALIGNANCY

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Specify Site (malignancy other than study site)
Descrizione

SpecifySite(malignancyotherthanstudysite)

Tipo di dati

text

DATE ERADICATED (mm/yyyy If not NED from second malignancy, leave date blank.)
Descrizione

DATEERADICATED

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus Property
C20985
UMLS 2011AA Property
C0547070
DATE OF INITIAL DIAGNOSIS OF PRIMARY TUMOR (5 HISTOPATHOLOGIC TYPE)
Descrizione

FirstPositiveBiopsyDate

Tipo di dati

date

HISTOLOGIC TYPE
Descrizione

HistologicType

Tipo di dati

text

Other, specify (histologic type) (B)
Descrizione

Other,specify(histologictype)

Tipo di dati

text

GLEASON SCORE, PRIMARY PATTERN ([most frequently seen] 1-5, 9=unknown)
Descrizione

GleasonScore,PrimaryPattern

Tipo di dati

float

GLEASON SCORE, SECONDARY PATTERN ([second most frequently seen] 1-5, 9=unknown)
Descrizione

GleasonScore,SecondaryPattern

Tipo di dati

float

GLEASON SCORE, WORST PATTERN ([worst pathological grade seen in any specimen] 1-5, 9=unknown)
Descrizione

GleasonScore,WorstPattern

Tipo di dati

float

GLEASON SCORE, COMBINED ([sum of the primary and secondary, unless unknown] 99=Unknown)
Descrizione

GleasonScore,Combined

Tipo di dati

float

ALKALINE PHOSPHATASE
Descrizione

ALKALINEPHOSPHATASE

Tipo di dati

text

Alk Phos Value
Descrizione

AlkPhosValue

Tipo di dati

float

SPECIFY (unit of measure)
Descrizione

SPECIFY(unitofmeasure)

Tipo di dati

text

Lab normal range (alkaline phosphatase) (B)
Descrizione

Labnormalrange(alkalinephosphatase)

Tipo di dati

text

ALT (SGPT)
Descrizione

ALT(SGPT)

Tipo di dati

text

ALT Value
Descrizione

ALTValue

Tipo di dati

float

Lab normal range (ALT) (C)
Descrizione

LaboratoryProcedureSerumGlutamicPyruvicTransaminaseResultNormalRangeText

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C25293
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ValueDomain-2
C14165
NCI Thesaurus ValueDomain-3
C38013
UMLS CUI-1
C0376147
UMLS CUI-2
C0086715
TOTAL BILIRUBIN
Descrizione

TOTALBILIRUBIN

Tipo di dati

text

Total Bilirubin Value
Descrizione

Total Bilirubin Value

Tipo di dati

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS CUI-1
C1278039
Lab normal range (total bilirubin) (11 BASELINE PSA VALUE)
Descrizione

Labnormalrange(totalbilirubin)

Tipo di dati

text

Baseline PSA Date
Descrizione

BaselinePSADate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Baseline PSA Value
Descrizione

Baseline PSA Value

Tipo di dati

float

Alias
UMLS CUI-1
C0138741
TIME POINT (12 GU DYSFUNCTION AT STUDY ENTRY Use CTC 2.0 to code severity)
Descrizione

TIMEPOINT

Tipo di dati

text

URINARY INCONTINENCE, Severity Grade (0-3)
Descrizione

URINARYINCONTINENCE,SeverityGrade

Tipo di dati

text

URINARY INCONTINENCE, Attribution
Descrizione

URINARYINCONTINENCE,Attribution

Tipo di dati

text

Other (attribution, urinary incontinence)
Descrizione

Other(attribution,urinaryincontinence)

Tipo di dati

text

URINARY FREQUENCY/URGENCY, Severity Grade (0-3)
Descrizione

URINARYFREQUENCY/URGENCY,SeverityGrade

Tipo di dati

text

URINARY FREQUENCY/URGENCY, Attribution
Descrizione

URINARYFREQUENCY/URGENCY,Attribution

Tipo di dati

text

Other (attribution, urinary frequency/urgency)
Descrizione

Other(attribution,urinaryfrequency/urgency)

Tipo di dati

text

ERECTILE IMPOTENCE, Severity Grade (0-3)
Descrizione

ERECTILEIMPOTENCE,SeverityGrade

Tipo di dati

text

ERECTILE IMPOTENCE, Attribution
Descrizione

ERECTILEIMPOTENCE,Attribution

Tipo di dati

text

Other (erectile impotence) (13)
Descrizione

Other(erectileimpotence)

Tipo di dati

text

T STAGE, PATHOLOGIC (14A)
Descrizione

TStage,Pathologic

Tipo di dati

text

N STAGE, PATHOLOGIC (SURGICAL)
Descrizione

NStage,Pathologic

Tipo di dati

text

N STAGE, CLINICAL (RADIOGRAPHIC)
Descrizione

NStage,Clinical

Tipo di dati

text

ROACH RISK CALCULATION (15)
Descrizione

ROACHRISKCALCULATION

Tipo di dati

text

M STAGE, CLINICAL
Descrizione

MStage,Clinical

Tipo di dati

text

Prostate: Prior Treatment
Descrizione

Prostate: Prior Treatment

Alias
UMLS CUI-1
C1514463
PRIOR PROSTATECTOMY
Descrizione

PriorProstatectomyInd

Tipo di dati

boolean

Prior prostatectomy date
Descrizione

PriorProstatectomyDate

Tipo di dati

date

POSITIVE SURGICAL MARGINS
Descrizione

POSITIVESURGICALMARGINS

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
SEMINAL VESICLE INVASION (pathologic)
Descrizione

SEMINALVESICLEINVASION

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
PRIOR RADIATION THERAPY
Descrizione

PRIORRADIATIONTHERAPY

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Specify (prior radiation therapy) (8)
Descrizione

Specify(priorradiationtherapy)

Tipo di dati

text

PRIOR CHEMOTHERAPY (for any reason)
Descrizione

PRIOR CHEMOTHERAPY (for any reason)

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C1514457
Prior chemotherapy end date (9)
Descrizione

PriorChemotherapyEndDate

Tipo di dati

date

PRIOR HORMONAL THERAPY (A)
Descrizione

PRIORHORMONALTHERAPY

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
PRIOR HORMONAL THERAPY TYPE FINASTERIDE
Descrizione

PRIORHORMONALTHERAPYTYPEFINASTERIDE

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Prior hormonal therapy end date (C)
Descrizione

PriorHormonalTherapyEndDate

Tipo di dati

date

PRIOR HORMONAL THERAPY TYPE TESTOSTERONE
Descrizione

PRIORHORMONALTHERAPYTYPETESTOSTERONE

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
PRIOR OTHER HORMONAL THERAPY
Descrizione

PRIOROTHERHORMONALTHERAPY

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS 2011AA ValueDomain
C1522602
Specify (prior other hormonal therapy)
Descrizione

Specify(priorotherhormonaltherapy)

Tipo di dati

text

Date prior other hormonal therapy started (D)
Descrizione

PriorOtherHormonalTherapyBeginDate

Tipo di dati

date

ORCHIECTOMY
Descrizione

ORCHIECTOMY

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C0029189
Orchiectomy date
Descrizione

Orchiectomy date

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C15288
NCI Thesaurus Property
C25275
UMLS CUI-1
C0029189
UMLS CUI-2
C0011008
PRIOR OR CURRENT COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) THERAPY
Descrizione

PRIORORCURRENTCOMPLEMENTARYALTERNATIVEMEDICINE(CAM)THERAPY

Tipo di dati

boolean

Alias
NCI Thesaurus ValueDomain
C25180
UMLS CUI-1
C0002346
Specify (prior or current complementary alternative medicine therapy)
Descrizione

Specify(priororcurrentcomplementaryalternativemedicinetherapy)

Tipo di dati

text

Date prior or current CAM therapy started
Descrizione

DatepriororcurrentCAMtherapystarted

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
Prior CAM therapy end date (if continuing leave blank)
Descrizione

PriorCAMtherapyenddate

Tipo di dati

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
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Similar models

INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in the codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.

1 moduli
  1. StudyEvent: I1 Radiation Therapy Oncology Group Phase III Randomized Study of Adjuvant Therapy for High Risk pT3NO Prostate Cancer Initial Evaluation Form
    1. INSTRUCTIONS: Submit this form at patient's entry on study. Use -1 for unknown or not applicable unless otherwise specified in the codetable. All dates to be reported mm-dd-yyyy unless otherwise indicated.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Header
RTOGStudy
Item
RTOG Study
text
Case#
Item
Case #
text
InstitutionName
Item
Institution Name
text
InstitutionNo.
Item
Institution No.
text
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
AmendedData
Item
AMENDED DATA
text
Comments
Item
COMMENTS
text
Signature
Item
Signature
text
Date
Item
Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
Item Group
Patient data
PatientBirthDate
Item
PATIENT BIRTH DATE (2)
date
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
Item
PERFORMANCE STATUS (3)
text
CL.1
Code List
PERFORMANCE STATUS (3)
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
CL Item
4 (4)
CL Item
-1 (-1)
HASPATIENTHADANOTHERMALIGNANCY
Item
HAS PATIENT HAD ANOTHER MALIGNANCY (other than study site)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
SpecifySite(malignancyotherthanstudysite)
Item
Specify Site (malignancy other than study site)
text
DATEERADICATED
Item
DATE ERADICATED (mm/yyyy If not NED from second malignancy, leave date blank.)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C20985 (NCI Thesaurus Property)
C0547070 (UMLS 2011AA Property)
FirstPositiveBiopsyDate
Item
DATE OF INITIAL DIAGNOSIS OF PRIMARY TUMOR (5 HISTOPATHOLOGIC TYPE)
date
Item
HISTOLOGIC TYPE
text
CL.3
Code List
HISTOLOGIC TYPE
CL Item
Adenocarcinoma_2005009 (Adenocarcinoma)
CL Item
Other_specify_2005013 (Other, specify)
CL Item
Unknown or not applicable (Unknown or not applicable)
Other,specify(histologictype)
Item
Other, specify (histologic type) (B)
text
GleasonScore,PrimaryPattern
Item
GLEASON SCORE, PRIMARY PATTERN ([most frequently seen] 1-5, 9=unknown)
float
GleasonScore,SecondaryPattern
Item
GLEASON SCORE, SECONDARY PATTERN ([second most frequently seen] 1-5, 9=unknown)
float
GleasonScore,WorstPattern
Item
GLEASON SCORE, WORST PATTERN ([worst pathological grade seen in any specimen] 1-5, 9=unknown)
float
GleasonScore,Combined
Item
GLEASON SCORE, COMBINED ([sum of the primary and secondary, unless unknown] 99=Unknown)
float
Item
ALKALINE PHOSPHATASE
text
CL.18
Code List
ALKALINE PHOSPHATASE
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal, Elevated (Abnormal, elevated)
CL Item
Abnormal, < Normal (Abnormal, < normal)
AlkPhosValue
Item
Alk Phos Value
float
Item
SPECIFY (unit of measure)
text
CL.19
Code List
SPECIFY (unit of measure)
CL Item
U/ml (u/ml)
CL Item
U/l (u/l)
Labnormalrange(alkalinephosphatase)
Item
Lab normal range (alkaline phosphatase) (B)
text
Item
ALT (SGPT)
text
CL.20
Code List
ALT (SGPT)
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal, Elevated (Abnormal, elevated)
CL Item
Abnormal, < Normal (Abnormal, < normal)
ALTValue
Item
ALT Value
float
ALT Normal Range
Item
Lab normal range (ALT) (C)
text
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C25293 (NCI Thesaurus Property-2)
C25704 (NCI Thesaurus ValueDomain)
C14165 (NCI Thesaurus ValueDomain-2)
C38013 (NCI Thesaurus ValueDomain-3)
C0376147 (UMLS CUI-1)
C0086715 (UMLS CUI-2)
Item
TOTAL BILIRUBIN
text
CL.21
Code List
TOTAL BILIRUBIN
CL Item
Not Done (Not done)
CL281691 (NCI Metathesaurus)
CL Item
Normal (Normal)
C14165 (NCI Thesaurus)
C0205307 (UMLS 2011AA)
CL Item
Abnormal, Elevated (Abnormal, elevated)
CL Item
Abnormal, < Normal (Abnormal, < normal)
TotalBilirubinValue
Item
Total Bilirubin Value
float
C25209 (NCI Thesaurus ValueDomain)
C1278039 (UMLS CUI-1)
Labnormalrange(totalbilirubin)
Item
Lab normal range (total bilirubin) (11 BASELINE PSA VALUE)
text
BaselinePSADate
Item
Baseline PSA Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
BaselinePSAValue
Item
Baseline PSA Value
float
C0138741 (UMLS CUI-1)
Item
TIME POINT (12 GU DYSFUNCTION AT STUDY ENTRY Use CTC 2.0 to code severity)
text
CL.22
Code List
TIME POINT (12 GU DYSFUNCTION AT STUDY ENTRY Use CTC 2.0 to code severity)
CL Item
Pre-surgery (Pre-surgery)
CL Item
Post-surgery (Post-surgery)
CL Item
Study Entry (Study entry)
CL Item
Pre-hormone (Pre-hormone)
Item
URINARY INCONTINENCE, Severity Grade (0-3)
text
CL.23
Code List
URINARY INCONTINENCE, Severity Grade (0-3)
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
Item
URINARY INCONTINENCE, Attribution
text
CL.24
Code List
URINARY INCONTINENCE, Attribution
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Surgical (Surgical)
C25698 (NCI Thesaurus)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Other(attribution,urinaryincontinence)
Item
Other (attribution, urinary incontinence)
text
Item
URINARY FREQUENCY/URGENCY, Severity Grade (0-3)
text
CL.25
Code List
URINARY FREQUENCY/URGENCY, Severity Grade (0-3)
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
Item
URINARY FREQUENCY/URGENCY, Attribution
text
CL.26
Code List
URINARY FREQUENCY/URGENCY, Attribution
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Surgical (Surgical)
C25698 (NCI Thesaurus)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Other(attribution,urinaryfrequency/urgency)
Item
Other (attribution, urinary frequency/urgency)
text
Item
ERECTILE IMPOTENCE, Severity Grade (0-3)
text
CL.27
Code List
ERECTILE IMPOTENCE, Severity Grade (0-3)
CL Item
0 (0)
C0919414 (NCI Metathesaurus)
CL Item
1 (1)
CL Item
2 (2)
C66833 (NCI Thesaurus)
C0205448 (UMLS 2011AA)
CL Item
3 (3)
Item
ERECTILE IMPOTENCE, Attribution
text
CL.28
Code List
ERECTILE IMPOTENCE, Attribution
CL Item
Not Applicable (Not applicable)
C48660 (NCI Thesaurus)
C1272460 (UMLS 2011AA)
CL Item
Surgical (Surgical)
C25698 (NCI Thesaurus)
CL Item
Other (Other)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
Other(erectileimpotence)
Item
Other (erectile impotence) (13)
text
Item
T STAGE, PATHOLOGIC (14A)
text
CL.29
Code List
T STAGE, PATHOLOGIC (14A)
CL Item
T2, Tumor Confined Within The Prostate (see Ajcc Definition) (T2, NOS)
CL Item
T2a, Tumor Confined Within The Prostate (see Ajcc Definition) (T2a)
CL Item
T2b, Tumor Confined Within The Prostate (see Ajcc Definition) (T2b)
CL Item
T3, Tumor Extends Through The Prostatic Capsule (see Ajcc Definition) (T3, NOS)
CL Item
T3a, Tumor Extends Through The Prostatic Capsule (see Ajcc Definition) (T3a)
CL Item
T3b, Tumor Extends Through The Prostatic Capsule (see Ajcc Definition) (T3b)
CL Item
T4, Tumor Is Fixed Or Invades Adjacent Structures (see Ajcc Definition) (T4)
CL Item
Primary Tumor Cannot Be Assessed (TX)
Item
N STAGE, PATHOLOGIC (SURGICAL)
text
CL.30
Code List
N STAGE, PATHOLOGIC (SURGICAL)
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastatis In Regional Lymph Node Or Nodes (see Ajcc Definition) (N1)
CL Item
No node sampling (No node sampling)
Item
N STAGE, CLINICAL (RADIOGRAPHIC)
text
CL.31
Code List
N STAGE, CLINICAL (RADIOGRAPHIC)
CL Item
No Regional Lymph Node Metastasis (N0)
CL Item
Metastasis To Movable Ipsilateral Axillary Lymph Node(s) (N1)
CL Item
Regional Lymph Nodes Cannot Be Assessed (e.g., Previously Removed) (NX)
Item
ROACH RISK CALCULATION (15)
text
CL.32
Code List
ROACH RISK CALCULATION (15)
CL Item
<15% (<15%)
CL Item
>=15% (>=15%)
Item
M STAGE, CLINICAL
text
CL.33
Code List
M STAGE, CLINICAL
CL Item
No Distant Metastasis (M0)
CL Item
Distant Metastasis (M1)
C18206 (NCI Thesaurus)
C1269798 (UMLS 2011AA)
CL Item
Nonregional Lymph Node(s) (M1a)
CL Item
Bone(s) (M1b)
CL Item
Other Site(s) (M1c)
CL Item
Distant Metastsis Cannot Be Assessed (MX)
Item Group
Prostate: Prior Treatment
C1514463 (UMLS CUI-1)
PriorProstatectomyInd
Item
PRIOR PROSTATECTOMY
boolean
PriorProstatectomyDate
Item
Prior prostatectomy date
date
POSITIVESURGICALMARGINS
Item
POSITIVE SURGICAL MARGINS
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
SEMINALVESICLEINVASION
Item
SEMINAL VESICLE INVASION (pathologic)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
PRIORRADIATIONTHERAPY
Item
PRIOR RADIATION THERAPY
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
Specify(priorradiationtherapy)
Item
Specify (prior radiation therapy) (8)
text
PRIORCHEMOTHERAPY
Item
PRIOR CHEMOTHERAPY (for any reason)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1514457 (UMLS CUI-1)
PriorChemotherapyEndDate
Item
Prior chemotherapy end date (9)
date
PRIORHORMONALTHERAPY
Item
PRIOR HORMONAL THERAPY (A)
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
PRIORHORMONALTHERAPYTYPEFINASTERIDE
Item
PRIOR HORMONAL THERAPY TYPE FINASTERIDE
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
PriorHormonalTherapyEndDate
Item
Prior hormonal therapy end date (C)
date
PRIORHORMONALTHERAPYTYPETESTOSTERONE
Item
PRIOR HORMONAL THERAPY TYPE TESTOSTERONE
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
PRIOROTHERHORMONALTHERAPY
Item
PRIOR OTHER HORMONAL THERAPY
boolean
C25180 (NCI Thesaurus ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
Specify(priorotherhormonaltherapy)
Item
Specify (prior other hormonal therapy)
text
PriorOtherHormonalTherapyBeginDate
Item
Date prior other hormonal therapy started (D)
date
ORCHIECTOMY
Item
ORCHIECTOMY
boolean
C25180 (NCI Thesaurus ValueDomain)
C0029189 (UMLS CUI-1)
OrchiectomyDate
Item
Orchiectomy date
date
C25164 (NCI Thesaurus ValueDomain)
C15288 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C0029189 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
Alternative medicine
Item
PRIOR OR CURRENT COMPLEMENTARY ALTERNATIVE MEDICINE (CAM) THERAPY
boolean
C25180 (NCI Thesaurus ValueDomain)
C0002346 (UMLS CUI-1)
Alternative medicine, specify
Item
Specify (prior or current complementary alternative medicine therapy)
text
DatepriororcurrentCAMtherapystarted
Item
Date prior or current CAM therapy started
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
PriorCAMtherapyenddate
Item
Prior CAM therapy end date (if continuing leave blank)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
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