Confirmatory testing

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Confirmatory testing is another area of debate in Active Surveillance arena. Please share your experience.

Are you following an Active Surveillance protocol Grade Group 1 (Gleason 6) or Grade Group 2 (Gleason 3+4)?

Yes

Unsure

Clear selection

Which Gleason score/Grade group have you been diagnosed with?

Gleason 3+3=6 (Grade Group 1)

Gleason 3+4=7 (Grade Group 2)

Gleason 4+3 (Grade Group 3)

Gleason 8 (Grade Group 4) or higher

Unsure

Clear selection

How long have you been on Active Surveillance?

Six months or fewer

Seven months to eleven months

One to five years

Six to ten years

Eleven to fifteen years

Sixteen to twenty years

Twenty-one years and above

Uncertain

Clear selection

Did you have confirmatory testing of your prostate cancer?

Yes

Unsure

Clear selection

When did you undergo confirmatory testing following original diagnosis?

Three months or fewer after diagnosis?

Four to six months after diagnosis?

Seven to eleven months after diagnosis?

One year to one and a half years after diagnosis?

Nineteen months or more after diagnosis?

Unsure

Clear selection

How was your cancer confirmed?

Transrectal biopsy?

Transperineal biopsy?

Magnetic resonance imaging (MRI)?

Biomarker test?

Combination?

Unsure?

Clear selection

What type of biopsy would you prefer if you had another one?

Transrectal

Transperineal

Doesn't matter

Uncertain

Clear selection

If you had a transperineal procedure, where was it done?

In the urologist's office with local anesthesia.

In an outpatient surgical center under general anesthesia.

In a hospital OR under general anesthesia,

Uncertain

Does not apply

Clear selection

If you had a transperineal biopsy, how would you rate the level pain? 1 being the least; 5 being the most. (Only applies to those who have had transperineal biopsies.)

Least pain

Most pain

Clear selection

Did you have any side effects if you had a transrectal biopsy?

Sepsis

Infection

None

Clear selection

What is your age?

80 or above

70-79

60-69

50-59

49 or below

What is your race/ethnicity?

Black

Hispanic/Latino

White

East Asian

South Asian

Native American/First Nations

Mixed

Prefer not to say

Clear selection

Education

High school diploma or less

Some college

BS/BA

Master's degree

Advanced degree (MD, PhD, DDS, DVM)

Clear selection

Income

$49,000 or below

$50,000-$74,000

$75,000-$99.000

$100,000-$249,000

$250,000 and above

Prefer not to say

Clear selection

In what country do you live?

In what state/province do you live in US or Canada?

How would you characterize your area?

Major metro

Medium-sized city

Small town

Suburban

Unsure

Prefer not to say

Clear selection

Are you a paid subscriber to TheActive Surveillor.com?

Yes

Unsure

Clear selection

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms