Follow-Up Clinical Form

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Patient ID
Item
Indicate the patient's medical record number
integer
C1269815 (UMLS CUI [1])
Time Relative to Baseline
Item
Time Relative to Baseline (e.g. Baseline, 6 months follow-up, 1 year follow-up, ...)
text
C0439564 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
Item Group
Treatment Variables
C0087111 (UMLS CUI-1)
Item
Indicate if the patient received Androgen Deprivation Therapy
integer
C0279492 (UMLS CUI [1])
Code List
Indicate if the patient received Androgen Deprivation Therapy
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of Androgen Deprivation Therapy
Item
Indicate date patient started Androgen Deprivation Therapy
date
C0279492 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Stop of Androgen Deprivation Therapy
Item
Indicate date patient stopped Androgen Deprivation Therapy
date
C0279492 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate if Androgen Deprivation Therapy is ongoing
integer
C0279492 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Code List
Indicate if Androgen Deprivation Therapy is ongoing
CL Item
Treatment ongoing (1)
C0549178 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient received hormonal treatment other than Androgen Deprivation Therapy
integer
C0279025 (UMLS CUI [1])
Code List
Indicate if the patient received hormonal treatment other than Androgen Deprivation Therapy
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of hormonal therapy
Item
Indicate date patient started hormonal treatment other than Androgen Deprivation Therapy
date
C0279025 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Stop of hormonal therapy
Item
Indicate date patient stopped hormonal treatment other than Androgen Deprivation Therapy
date
C0279025 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate if hormonal therapy is ongoing
integer
C0279025 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Code List
Indicate if hormonal therapy is ongoing
CL Item
Treatment ongoing (1)
C0549178 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient received chemotherapy
integer
C0392920 (UMLS CUI [1])
Code List
Indicate if the patient received chemotherapy
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of chemotherapy
Item
Indicate date patient started chemotherapy
date
C1302181 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
Stop of chemotherapy
Item
Indicate date patient stopped chemotherapy
date
C1302181 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate if chemotherapy is ongoing
integer
C0549178 (UMLS CUI [1,1])
C0392920 (UMLS CUI [1,2])
Code List
Indicate if chemotherapy is ongoing
CL Item
Treatment ongoing (1)
C0549178 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient received immunotherapy
integer
C0021083 (UMLS CUI [1])
Code List
Indicate if the patient received immunotherapy
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of immunotherapy
Item
Indicate date patient started immunotherapy
date
C0021083 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Stop of immunotherapy
Item
Indicate date patient stopped immunotherapy
date
C0021083 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Indicate if immunotherapy is ongoing
integer
C0021083 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Code List
Indicate if immunotherapy is ongoing
CL Item
Treatment ongoing (1)
C0549178 (UMLS CUI-1)
(Comment:en)
Item
Indicate if the patient received radiopharmaceuticals
integer
C0182638 (UMLS CUI [1])
Code List
Indicate if the patient received radiopharmaceuticals
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of treatment with radiopharmaceuticals
Item
Indicate date patient started radiopharmaceuticals
date
C0182638 (UMLS CUI [1,1])
C3173309 (UMLS CUI [1,2])
Stop of treatment with radiopharmaceuticals
Item
Indicate date patient stopped radiopharmaceuticals
date
C0182638 (UMLS CUI [1,1])
C1531784 (UMLS CUI [1,2])
Item
Indicate if radiotherapy is ongoing
integer
C0182638 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Code List
Indicate if radiotherapy is ongoing
CL Item
Treatment ongoing (1)
C0549178 (UMLS CUI-1)
(Comment:en)
Interventions for complications of local progression: TURP
Item
Indicate if the patient received interventions for complications due to local progression 1 = TURP (transurethral resection of the prostate)
boolean
C0184661 (UMLS CUI [1,1])
C0178874 (UMLS CUI [1,2])
C1947913 (UMLS CUI [1,3])
C0040771 (UMLS CUI [2])
Interventions for complications of local progression: Ureteral Stent
Item
Indicate if the patient received interventions for complications due to local progression 2 = Ureteral stent
boolean
C0184661 (UMLS CUI [1,1])
C0178874 (UMLS CUI [1,2])
C1947913 (UMLS CUI [1,3])
C0183518 (UMLS CUI [2])
Interventions for complications of local progression: Percutaneous nephrostomy tube
Item
Indicate if the patient received interventions for complications due to local progression 3 = Percutaneous nephrostomy tube
boolean
C0184661 (UMLS CUI [1,1])
C0178874 (UMLS CUI [1,2])
C1947913 (UMLS CUI [1,3])
C0564457 (UMLS CUI [2])
Interventions for complications of local progression: Suprapubic catheter placement
Item
Indicate if the patient received interventions for complications due to local progression 4 = Suprapubic catheter placement
boolean
C0184661 (UMLS CUI [1,1])
C0178874 (UMLS CUI [1,2])
C1947913 (UMLS CUI [1,3])
C0150798 (UMLS CUI [2])
Interventions for complications of local progression: Chronic foley catheter / self intermittent catheterization
Item
Indicate if the patient received interventions for complications due to local progression 5 = Chronic foley catheter / self intermittent catheterization
boolean
C0184661 (UMLS CUI [1,1])
C0178874 (UMLS CUI [1,2])
C1947913 (UMLS CUI [1,3])
C0179804 (UMLS CUI [2])
C0473154 (UMLS CUI [3])
Date of TURP intervention needed for local progression
Item
Indicate date patient received TURP intervention for complications due to for local progression
date
C0040771 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of ureteral stent intervention needed for local progression
Item
Indicate date patient received ureteral stent intervention for complications due to for local progression
date
C0183518 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of percutaneous nephrostomy tube intervention needed for local progression
Item
Indicate date patient received percutaneous nephrostomy tube intervention for complications due to for local progression
date
C0564457 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of suprapubic catheter placement intervention needed for local progression
Item
Indicate date patient received suprapubic catheter placement intervention for complications due to for local progression
date
C0150798 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of chronic foley catheter / self intermittent catheterization intervention needed for local progression
Item
Indicate date patient received chronic foley catheter / self intermittent catheterization intervention for complications due to for local progression
date
C0179804 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0473154 (UMLS CUI [2,1])
C0011008 (UMLS CUI [2,2])
Item
Indicate if the patient received bisphosphonates or denosumab
integer
C0012544 (UMLS CUI [1])
C1690432 (UMLS CUI [2])
Code List
Indicate if the patient received bisphosphonates or denosumab
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)
Start of bisphosphonates or denosumab
Item
Indicate date patient started bisphosphonates or denosumab
date
C0012544 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
C1690432 (UMLS CUI [2,1])
C0808070 (UMLS CUI [2,2])
Stop of bisphosphonates or denosumab
Item
Indicate date patient stopped bisphosphonates or denosumab
date
C0012544 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
C1690432 (UMLS CUI [2,1])
C0806020 (UMLS CUI [2,2])
Item
Indicate if bisphosphonates or denosumab are ongoing
integer
C0012544 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C1690432 (UMLS CUI [2,1])
C0549178 (UMLS CUI [2,2])
Code List
Indicate if bisphosphonates or denosumab are ongoing
CL Item
Treatment ongoing (1)
C0549178 (UMLS CUI-1)
(Comment:en)
Item Group
Acute Complications of Treatment
C0087111 (UMLS CUI-1)
C0009566 (UMLS CUI-2)
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): No
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 0 = No grade III-IV toxicity
boolean
C1298908 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
C1515119 (UMLS CUI [1,3])
C1516728 (UMLS CUI [1,4])
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): Cytopenia
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 1 = Cytopenias (anemia, neutropenia, thrombocytopenia)
boolean
C0009566 (UMLS CUI [1,1])
C1515119 (UMLS CUI [1,2])
C1516728 (UMLS CUI [1,3])
C0010828 (UMLS CUI [1,4])
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): Infection
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 2 = Infection, any primary site
boolean
C0009566 (UMLS CUI [1,1])
C1515119 (UMLS CUI [1,2])
C1516728 (UMLS CUI [1,3])
C3714514 (UMLS CUI [1,4])
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): GI toxicity
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 3 = Vomiting, diarrhea, constipation, other GI toxicity
boolean
C0009566 (UMLS CUI [1,1])
C1515119 (UMLS CUI [1,2])
C1516728 (UMLS CUI [1,3])
C0521362 (UMLS CUI [1,4])
C0013221 (UMLS CUI [1,5])
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): Neuropathy
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 4 = Neuropathy, any type
boolean
C0009566 (UMLS CUI [1,1])
C1515119 (UMLS CUI [1,2])
C1516728 (UMLS CUI [1,3])
C0442874 (UMLS CUI [1,4])
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): cardiovascular toxicity
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 5 = Cardiovascular toxicity (heart attack, heart failure, arrhythmia)
boolean
C0009566 (UMLS CUI [1,1])
C1515119 (UMLS CUI [1,2])
C1516728 (UMLS CUI [1,3])
C0007226 (UMLS CUI [1,4])
C0013221 (UMLS CUI [1,5])
CTCAE grade III-IV complications due to systemic therapy (excluding ADT): other
Item
Indicate whether the patient experienced a CTCAE v 4.0 grade III-IV complication while on therapy and within 6 months after initiating treatment 888 = Other (free text)
boolean
C0205394 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
C1515119 (UMLS CUI [1,3])
C1516728 (UMLS CUI [1,4])
CTCAE grade III-IV complication due to systemic therapy (excluding ADT) other than those explicitly listed
Item
Indicate the CTCAE v 4.0 grade III-IV complication the patient experienced
text
C0205394 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
C1515119 (UMLS CUI [1,3])
C1516728 (UMLS CUI [1,4])
Date of cytopenias
Item
Indicate date of cytopenias
date
C0010828 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of infection
Item
Indicate date of infection
date
C0009450 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Date of vomiting, diarrhea, constipation, or other GI toxicity
Item
Indicate date of vomiting, diarrhea, constipation, or other GI toxicity
date
C0521362 (UMLS CUI [1,1])
C0013221 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Date of neuropathy
Item
Indicate date of neuropathy
date
C0442874 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date of cardiovascular toxicity
Item
Indicate date of cardiovascular toxicity
date
C0007226 (UMLS CUI [1,1])
C0013221 (UMLS CUI [1,2])
C2316983 (UMLS CUI [1,3])
Date of other complication
Item
Indicate date of other complication
date
C0009566 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Degree of Health
C0018759 (UMLS CUI-1)
Item
Indicate the ECOG/WHO performance status
integer
C1520224 (UMLS CUI [1,1])
C1298650 (UMLS CUI [1,2])
Code List
Indicate the ECOG/WHO performance status
CL Item
0 (0)
C1828078 (UMLS CUI-1)
(Comment:en)
CL Item
1 (1)
C1827388 (UMLS CUI-1)
(Comment:en)
CL Item
2 (2)
C1828242 (UMLS CUI-1)
(Comment:en)
CL Item
3 (3)
C1827126 (UMLS CUI-1)
(Comment:en)
CL Item
4 (4)
C1827528 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
C1520224 (UMLS CUI-2)
(Comment:en)
Item Group
Survival and disease control
C1148433 (UMLS CUI-1)
C0920467 (UMLS CUI-2)
Procedures needed for local progression: None
Item
Indicate if patient received any of the following procedures for local progression: 0 = None of the procedures
boolean
C0184661 (UMLS CUI [1,1])
C0449258 (UMLS CUI [1,2])
C0549184 (UMLS CUI [1,3])
Procedures needed for local progression: TURP
Item
Indicate if patient received any of the following procedures for local progression: 1 = TURP (transurethral resection of the prostate)
boolean
C0184661 (UMLS CUI [1,1])
C0449258 (UMLS CUI [1,2])
C0040771 (UMLS CUI [1,3])
Procedures needed for local progression: Ureteral Stent
Item
Indicate if patient received any of the following procedures for local progression: 2 = Ureteral stent
boolean
C0184661 (UMLS CUI [1,1])
C0449258 (UMLS CUI [1,2])
C0183518 (UMLS CUI [1,3])
Procedures needed for local progression: Percutaneous nephrostomy tube
Item
Indicate if patient received any of the following procedures for local progression: 3 = Percutaneous nephrostomy tube
boolean
C0184661 (UMLS CUI [1,1])
C0449258 (UMLS CUI [1,2])
C0564457 (UMLS CUI [1,3])
Procedures needed for local progression: Suprapubic catheter
Item
Indicate if patient received any of the following procedures for local progression: 4 = Suprapubic catheter placement
boolean
C0184661 (UMLS CUI [1,1])
C0449258 (UMLS CUI [1,2])
C0150798 (UMLS CUI [1,3])
Procedures needed for local progression: Chronic foley catheter / self intermittent catheterization
Item
Indicate if patient received any of the following procedures for local progression: 5 = Chronic foley catheter / self intermittent catheterization
boolean
C0184661 (UMLS CUI [1,1])
C0449258 (UMLS CUI [1,2])
C0179804 (UMLS CUI [1,3])
C0184661 (UMLS CUI [2,1])
C0449258 (UMLS CUI [2,2])
C0473154 (UMLS CUI [2,3])
Item
Indicate if the patient has a symptomatic fracture, cord compression or need for surgery or radiation to bone
integer
C0242656 (UMLS CUI [1,1])
C0153690 (UMLS CUI [1,2])
C0231220 (UMLS CUI [1,3])
Code List
Indicate if the patient has a symptomatic fracture, cord compression or need for surgery or radiation to bone
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Date of symptomatic skeletal related event
Item
Indicate date of Symptomatic Skeletal Related Event
date
C0153690 (UMLS CUI [1,1])
C0231220 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Indicate if the patient was diagnosed with metastatic disease
integer
C0242656 (UMLS CUI [1,1])
C2939420 (UMLS CUI [1,2])
Code List
Indicate if the patient was diagnosed with metastatic disease
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Date of diagnosed metastasis
Item
Indicate date of metastasis
date
C2316983 (UMLS CUI [1,1])
C0027627 (UMLS CUI [1,2])
Item
Indicate if the patient was diagnosed with castration resistant disease
integer
C0242656 (UMLS CUI [1,1])
C3658267 (UMLS CUI [1,2])
Code List
Indicate if the patient was diagnosed with castration resistant disease
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Date of castration-resistant disease
Item
Indicate date of castration-resistant disease
date
C3658267 (UMLS CUI [1,1])
C2316983 (UMLS CUI [1,2])
Item
Indicate if the patient has died
integer
C0011065 (UMLS CUI [1])
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
Death: Date of death
Item
Indicate date of death
date
C1148348 (UMLS CUI [1])
Item
Indicate if death is noted to be directly attributable to prostate cancer
integer
C0007465 (UMLS CUI [1,1])
C0596130 (UMLS CUI [1,2])
C0600139 (UMLS CUI [1,3])
Code List
Indicate if death is noted to be directly attributable to prostate cancer
CL Item
Yes (1)
C1705108 (UMLS CUI-1)
(Comment:en)
CL Item
No (0)
C1298908 (UMLS CUI-1)
(Comment:en)
CL Item
Unknown (999)
C0439673 (UMLS CUI-1)
(Comment:en)

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