This has been a very helpful tool for me. I use to fill it in every appointment and copy. Then I took it to all appointments. I'm slacking the last 3 years though. I hope it's helpful.
Your preferred name: (the name you use to sign your posts)
Patient’s name or nickname:
Your relationship to him:
Age at Diagnosis:
Patient's general health:
Is there any family history of breast or prostate cancer?
Date of DRE:
DRE positive or negative:
(It is positive if the doctor felt something)
Stage given at time of DRE:
(The doctor stages the disease at the time of the DRE)
Past PSA history: (5 years if available)
Date of Biopsy:
Gleason score assigned by local pathologist:
Gleason score assigned by expert pathologist: (If slides sent for second opinion)
Bone or CT scans: (results)
Endorectal MRI or ProstaScint: (findings)
Other Blood tests: (findings)
OTHER DOCTORS CONSULTED and their opinions, advice or findings.
History of treatments and results in chronological order since diagnosis, including pathology results after surgery if applicable, and additional info if initial treatment failed.
List all medications taken, including ones for pain.
Anything else you’d like us to know about you (eg children, your own health)