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8545

Description

Prostate Cancer - Localized Disease On-Study Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DC4FD317-E0EB-5D4E-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DC4FD317-E0EB-5D4E-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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    On-Study - Prostate Cancer - Localized Disease On-Study Form - 2262683v3.0

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: Prostate Cancer - Localized Disease On-Study Form
      1. No Instruction available.
    Crf Header
    Description

    Crf Header

    Coordinating Group Protocol No.
    Description

    Protocol ID Coordinating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1711341
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Coordinating Group Code
    Description

    Coordinating Group Code

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS CUI-1
    C1711341
    NCI Thesaurus ObjectClass
    C17005
    UMLS CUI-2
    C0805701
    NCI Thesaurus ObjectClass-2
    C25462
    NCI Thesaurus Property
    C25364
    Protocol Title
    Description

    Protocol Title

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986303
    NCI Thesaurus ObjectClass
    C25320
    NCI Thesaurus Property
    C42774
    Patient Study ID
    Description

    Patient Study ID

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25462
    NCI Thesaurus Property-2
    C25364
    Institution/Affiliate
    Description

    Institution or Affiliate

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C25454
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Other Patient ID
    Description

    Trial subject ID Participating Group

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C2347449
    NCI Thesaurus Property
    C25608
    NCI Thesaurus Property-2
    C25364
    Participating Group Code
    Description

    ParticipatingGroupIdentifierCode

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25162
    UMLS 2011AA ValueDomain
    C0805701
    NCI Thesaurus ObjectClass
    C25608
    UMLS 2011AA ObjectClass
    C0679823
    NCI Thesaurus ObjectClass-2
    C17005
    UMLS 2011AA ObjectClass-2
    C1257890
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Patient Name (initials acceptable)
    Description

    Patient Name

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1299487
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25364
    Prostate: Disease Description - Localized
    Description

    Prostate: Disease Description - Localized

    Date of Initial Diagnosis of Primary Tumor (first positive biopsy date)
    Description

    FirstBiopsyPositiveDate

    Data type

    date

    Alias
    NCI Thesaurus ObjectClass
    C15189
    UMLS 2011AA ObjectClass
    C0005558
    NCI Thesaurus ObjectClass-2
    C25509
    UMLS 2011AA ObjectClass-2
    C1279901
    NCI Thesaurus Property
    C25246
    UMLS 2011AA Property
    C1446409
    NCI Thesaurus Property-2
    C25275
    UMLS 2011AA Property-2
    C2745955
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Baseline PSA Value (per protocol definition)
    Description

    LaboratoryProcedureBaselineProstate-SpecificAntigenOutcomeValue

    Data type

    float

    Measurement units
    • ng/ml
    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C17525
    UMLS 2011AA Property
    C0138741
    NCI Thesaurus Property-2
    C25213
    UMLS 2011AA Property-2
    C1442488
    NCI Thesaurus Property-3
    C20200
    UMLS 2011AA Property-3
    C1274040
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    ng/ml
    Unit of Measure ([n/mg, ng/mL, U/L, mg/L, ng/dL, mcg/L])
    Description

    AssessmentLabUOM

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C20989
    UMLS 2011AA ObjectClass
    C0031809
    NCI Thesaurus Property
    C37984
    UMLS 2011AA Property
    C0022877
    NCI Thesaurus ValueDomain
    C25709
    UMLS 2011AA ValueDomain
    C1519795
    Date of Baseline PSA
    Description

    BaselinePSADate

    Data type

    date

    Alias
    NCI Thesaurus ObjectClass
    C17525
    UMLS 2011AA ObjectClass
    C0138741
    NCI Thesaurus ObjectClass-2
    C25213
    UMLS 2011AA ObjectClass-2
    C1442488
    NCI Thesaurus Property
    C25275
    UMLS 2011AA Property
    C2745955
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ValueDomain-2
    C25367
    Gleason Score, Primary Pattern (1-5, 9:unknown)
    Description

    GleasonScorePrimaryPatternValue

    Data type

    float

    Alias
    NCI Thesaurus Property
    C25251
    UMLS 2011AA Property
    C0205225
    NCI Thesaurus ObjectClass
    C28084
    UMLS 2011AA ObjectClass
    C0332326
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property-2
    C25336
    UMLS 2011AA Property-2
    C0449774
    Gleason Score, Secondary Pattern (1-5, 9:unknown)
    Description

    GleasonScoreSecondaryPatternValue

    Data type

    float

    Alias
    NCI Thesaurus Property
    C25667
    UMLS 2011AA Property
    C0175668
    NCI Thesaurus ObjectClass
    C28084
    UMLS 2011AA ObjectClass
    C0332326
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property-2
    C25336
    UMLS 2011AA Property-2
    C0449774
    Gleason Score, Worst Pattern (1-5, 9:unknown)
    Description

    GleasonScoreWorstPatternValue

    Data type

    float

    Alias
    NCI Thesaurus ObjectClass
    C28084
    UMLS 2011AA ObjectClass
    C0332326
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property
    C25719
    UMLS 2011AA Property
    C1522166
    NCI Thesaurus Property-2
    C25336
    UMLS 2011AA Property-2
    C0449774
    Gleason Score Based on Specimen Type
    Description

    SpecimenGleasonScoreType

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C19157
    UMLS 2011AA ObjectClass
    C0370003
    NCI Thesaurus ObjectClass-2
    C28084
    UMLS 2011AA ObjectClass-2
    C0332326
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    Gleason Score, Combined (2-10 if primary and secondary patterns unavailable)
    Description

    GleasonScoreCombinedPatternValue

    Data type

    float

    Alias
    NCI Thesaurus Property
    C25454
    UMLS 2011AA Property
    C0205195
    NCI Thesaurus ObjectClass
    C28084
    UMLS 2011AA ObjectClass
    C0332326
    NCI Thesaurus ValueDomain
    C25712
    UMLS 2011AA ValueDomain
    C1522609
    NCI Thesaurus Property-2
    C25336
    UMLS 2011AA Property-2
    C0449774
    T Stage, Clinical (Clinical Stage use the AJCC staging system specified in the protocol)
    Description

    ProstateTumorClinicalTStage

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12410
    UMLS 2011AA ObjectClass-2
    C0033572
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C25728
    UMLS 2011AA Property-2
    C0475455
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
    N Stage, Clinical
    Description

    ProstateTumorClinicalNStage

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12410
    UMLS 2011AA ObjectClass-2
    C0033572
    NCI Thesaurus Property
    C25398
    UMLS 2011AA Property
    C0205210
    NCI Thesaurus Property-2
    C25580
    UMLS 2011AA Property-2
    C0456532
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
    T Stage, Pathologic (Pathologic Stage use the AJCC staging system specified in the protocol)
    Description

    ProstateTumorPathologicTStage

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12410
    UMLS 2011AA ObjectClass-2
    C0033572
    NCI Thesaurus Property
    C25610
    UMLS 2011AA Property
    C1521733
    NCI Thesaurus Property-2
    C25728
    UMLS 2011AA Property-2
    C0475455
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
    N Stage, Pathologic
    Description

    ProstateTumorPathologicNStage

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C3262
    UMLS 2011AA ObjectClass
    C0027651
    NCI Thesaurus ObjectClass-2
    C12410
    UMLS 2011AA ObjectClass-2
    C0033572
    NCI Thesaurus Property
    C25610
    UMLS 2011AA Property
    C1521733
    NCI Thesaurus Property-2
    C25580
    UMLS 2011AA Property-2
    C0456532
    NCI Thesaurus ValueDomain
    C16899
    UMLS 2011AA ValueDomain
    C1300072
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    1 forms
    1. StudyEvent: Prostate Cancer - Localized Disease On-Study Form
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Crf Header
    Protocol ID Coordinating Group
    Item
    Coordinating Group Protocol No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1711341 (UMLS CUI-2)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Coordinating Group Code
    Item
    Coordinating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C1711341 (UMLS CUI-1)
    C17005 (NCI Thesaurus ObjectClass)
    C0805701 (UMLS CUI-2)
    C25462 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    Protocol Title
    Item
    Protocol Title
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986303 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C42774 (NCI Thesaurus Property)
    Patient Study ID
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25462 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    Institution or Affiliate
    Item
    Institution/Affiliate
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C25454 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ObjectClass-2)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Trial subject ID Participating Group
    Item
    Other Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C2347449 (UMLS CUI-2)
    C25608 (NCI Thesaurus Property)
    C25364 (NCI Thesaurus Property-2)
    ParticipatingGroupIdentifierCode
    Item
    Participating Group Code
    text
    C25162 (NCI Thesaurus ValueDomain)
    C0805701 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus ObjectClass)
    C0679823 (UMLS 2011AA ObjectClass)
    C17005 (NCI Thesaurus ObjectClass-2)
    C1257890 (UMLS 2011AA ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Patient Name
    Item
    Patient Name (initials acceptable)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1299487 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25364 (NCI Thesaurus Property)
    Item Group
    Prostate: Disease Description - Localized
    FirstBiopsyPositiveDate
    Item
    Date of Initial Diagnosis of Primary Tumor (first positive biopsy date)
    date
    C15189 (NCI Thesaurus ObjectClass)
    C0005558 (UMLS 2011AA ObjectClass)
    C25509 (NCI Thesaurus ObjectClass-2)
    C1279901 (UMLS 2011AA ObjectClass-2)
    C25246 (NCI Thesaurus Property)
    C1446409 (UMLS 2011AA Property)
    C25275 (NCI Thesaurus Property-2)
    C2745955 (UMLS 2011AA Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    LaboratoryProcedureBaselineProstate-SpecificAntigenOutcomeValue
    Item
    Baseline PSA Value (per protocol definition)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C17525 (NCI Thesaurus Property)
    C0138741 (UMLS 2011AA Property)
    C25213 (NCI Thesaurus Property-2)
    C1442488 (UMLS 2011AA Property-2)
    C20200 (NCI Thesaurus Property-3)
    C1274040 (UMLS 2011AA Property-3)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    Item
    Unit of Measure ([n/mg, ng/mL, U/L, mg/L, ng/dL, mcg/L])
    text
    C20989 (NCI Thesaurus ObjectClass)
    C0031809 (UMLS 2011AA ObjectClass)
    C37984 (NCI Thesaurus Property)
    C0022877 (UMLS 2011AA Property)
    C25709 (NCI Thesaurus ValueDomain)
    C1519795 (UMLS 2011AA ValueDomain)
    CL.1
    Code List
    Unit of Measure ([n/mg, ng/mL, U/L, mg/L, ng/dL, mcg/L])
    CL Item
    N/milligram (n/mg)
    CL Item
    Nanograms Per Milliliter (ng/mL)
    CL Item
    Units Per Liter (U/L)
    CL Item
    Milligrams Per Liter (mg/L)
    CL Item
    Nanograms Per Deciliter (ng/dL)
    CL Item
    Micrograms Per Liter (mcg/L)
    BaselinePSADate
    Item
    Date of Baseline PSA
    date
    C17525 (NCI Thesaurus ObjectClass)
    C0138741 (UMLS 2011AA ObjectClass)
    C25213 (NCI Thesaurus ObjectClass-2)
    C1442488 (UMLS 2011AA ObjectClass-2)
    C25275 (NCI Thesaurus Property)
    C2745955 (UMLS 2011AA Property)
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    GleasonScorePrimaryPatternValue
    Item
    Gleason Score, Primary Pattern (1-5, 9:unknown)
    float
    C25251 (NCI Thesaurus Property)
    C0205225 (UMLS 2011AA Property)
    C28084 (NCI Thesaurus ObjectClass)
    C0332326 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25336 (NCI Thesaurus Property-2)
    C0449774 (UMLS 2011AA Property-2)
    GleasonScoreSecondaryPatternValue
    Item
    Gleason Score, Secondary Pattern (1-5, 9:unknown)
    float
    C25667 (NCI Thesaurus Property)
    C0175668 (UMLS 2011AA Property)
    C28084 (NCI Thesaurus ObjectClass)
    C0332326 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25336 (NCI Thesaurus Property-2)
    C0449774 (UMLS 2011AA Property-2)
    GleasonScoreWorstPatternValue
    Item
    Gleason Score, Worst Pattern (1-5, 9:unknown)
    float
    C28084 (NCI Thesaurus ObjectClass)
    C0332326 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25719 (NCI Thesaurus Property)
    C1522166 (UMLS 2011AA Property)
    C25336 (NCI Thesaurus Property-2)
    C0449774 (UMLS 2011AA Property-2)
    Item
    Gleason Score Based on Specimen Type
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C19157 (NCI Thesaurus ObjectClass)
    C0370003 (UMLS 2011AA ObjectClass)
    C28084 (NCI Thesaurus ObjectClass-2)
    C0332326 (UMLS 2011AA ObjectClass-2)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    CL.2
    Code List
    Gleason Score Based on Specimen Type
    CL Item
    Biopsy (Biopsy (including TURP))
    C15189 (NCI Thesaurus)
    C0005558 (UMLS 2011AA)
    C15189 (NCI Thesaurus-3)
    C0005558 (UMLS 2011AA-4)
    CL Item
    Surgical Specimen (Surgical specimen)
    GleasonScoreCombinedPatternValue
    Item
    Gleason Score, Combined (2-10 if primary and secondary patterns unavailable)
    float
    C25454 (NCI Thesaurus Property)
    C0205195 (UMLS 2011AA Property)
    C28084 (NCI Thesaurus ObjectClass)
    C0332326 (UMLS 2011AA ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    C1522609 (UMLS 2011AA ValueDomain)
    C25336 (NCI Thesaurus Property-2)
    C0449774 (UMLS 2011AA Property-2)
    ProstateTumorClinicalTStage
    Item
    T Stage, Clinical (Clinical Stage use the AJCC staging system specified in the protocol)
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12410 (NCI Thesaurus ObjectClass-2)
    C0033572 (UMLS 2011AA ObjectClass-2)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C25728 (NCI Thesaurus Property-2)
    C0475455 (UMLS 2011AA Property-2)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
    ProstateTumorClinicalNStage
    Item
    N Stage, Clinical
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12410 (NCI Thesaurus ObjectClass-2)
    C0033572 (UMLS 2011AA ObjectClass-2)
    C25398 (NCI Thesaurus Property)
    C0205210 (UMLS 2011AA Property)
    C25580 (NCI Thesaurus Property-2)
    C0456532 (UMLS 2011AA Property-2)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
    ProstateTumorPathologicTStage
    Item
    T Stage, Pathologic (Pathologic Stage use the AJCC staging system specified in the protocol)
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12410 (NCI Thesaurus ObjectClass-2)
    C0033572 (UMLS 2011AA ObjectClass-2)
    C25610 (NCI Thesaurus Property)
    C1521733 (UMLS 2011AA Property)
    C25728 (NCI Thesaurus Property-2)
    C0475455 (UMLS 2011AA Property-2)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
    ProstateTumorPathologicNStage
    Item
    N Stage, Pathologic
    text
    C3262 (NCI Thesaurus ObjectClass)
    C0027651 (UMLS 2011AA ObjectClass)
    C12410 (NCI Thesaurus ObjectClass-2)
    C0033572 (UMLS 2011AA ObjectClass-2)
    C25610 (NCI Thesaurus Property)
    C1521733 (UMLS 2011AA Property)
    C25580 (NCI Thesaurus Property-2)
    C0456532 (UMLS 2011AA Property-2)
    C16899 (NCI Thesaurus ValueDomain)
    C1300072 (UMLS 2011AA ValueDomain)
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