GENERAL
Hi Everyone 
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:
Location/Country: (optional)
Age at Diagnosis:
Patient's general health:
Is there any family history of breast or prostate cancer?
DOCTOR'S INFORMATION
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)
PSA
Past PSA history: (5 years if available)
BIOPSY INFORMATION
Date of Biopsy:
Gleason score assigned by local pathologist:
Gleason score assigned by expert pathologist: (If slides sent for second opinion)
OTHER TESTS
Bone or CT scans: (results)
Endorectal MRI or ProstaScint: (findings)
Other Blood tests: (findings)
OTHER DOCTORS CONSULTED and their opinions, advice or findings.
Radiation Oncologist:
Medical Oncologist:
Other:
TREATMENT HISTORY
History of treatments and results in chronological order since diagnosis, including pathology results after surgery if applicable, and additional info if initial treatment failed.
MEDICATION.
List all medications taken, including ones for pain.
OTHER INFORMATION
Anything else you’d like us to know about you (eg children, your own health)
Rationale for blind radiation to the bed of the prostate
Sally Jones-oncologist??
Unsure of best option in early prostate cancer diagnosis.
Advice / Opinions needed for My Brother Biopsy Results GL 6 
64 year old - Stage 4 Metastadized Prostate Cancer Patient at MDA
