NEWLY DIAGNOSED WORKSHEET
INFORMATION ABOUT YOUR PROSTATE CANCER Use this worksheet to keep track of basic information about your prostate cancer diagnosis as you need in order to make your decisions about your care. Date of diagnosis ______________________________________________________________________________ PSA level at diagnosis __________________________________________________________________________ Gleason score __________________________________ Grade Group _________________________________ Number of biopsy samples taken ________________________________________________________________ Number of biopsy samples containing cancer _____________________________________________________ Stage at diagnosis (I-IV) _________________________________________________________________________ Nodal involvement? Yes No My cancer is: Localized (only in the prostate) Locally advanced (spread to just outside the prostate) Advanced or Metastatic (spread to other organs or parts of the body) Location of metastasis (spread) ___________________________________________ Date Follow-up Tests Results _____________________ CT Scan ____________________________________________________ _____________________ MRI ____________________________________________________ _____________________ PET or PET/CT Scan ______________________________________________________ _____________________ Other tests ____________________________________________________ PHYSICIANS Prostate cancer diagnosed by: Name: ___________________________________________ Contact information: _______________________ Other doctors or healthcare providers seen: Name: ___________________________________________ Contact information: _______________________ Name: ___________________________________________ Contact information: _______________________ Name: ___________________________________________ Contact information: _______________________ Other important numbers: _______________________________________________________________________ LEARN MORE We encourage you to use this information in conversations with your healthcare team about prostate cancer and related topics. For more information about prostate cancer and ZERO Prostate Cancer, visit our website zerocancer.org/learn . ZERO Prostate Cancer provides this information as a service. It is not intended to take the place of medical professionals or the recommendations of your healthcare team. We strongly suggest consulting your healthcare team if you have questions about your specific care.
A PATIENT EDUCATION SERIES
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