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Prostate Cancer Patient Consultation Form - The Prostate Net

Prostate Cancer Patient Consultation Form - The Prostate Net 2026

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The document is a Prostate Cancer Patient Consultation Form that collects essential patient information regarding symptoms, diagnostic tests, and evaluations related to prostate cancer. It includes sections for detection of symptoms, evaluation results from various imaging and blood tests, diagnosis details including tumor characteristics, treatment options available, potential side effects, and prognosis. Additionally, it provides space for notes and recommendations for second opinions from specialists.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information at the top of the form, including your name and address. This ensures that your consultation is personalized.
In the DETECTION section, provide details about your symptoms and PSA levels. Fill in the initial PSA, normal range, and most recent PSA values accurately.
For EVALUATION, answer the questions regarding various tests like DRE and imaging procedures by marking 'Yes' or 'No'. Include any relevant results for tests such as RT-PCR Blood Assay.
In the DIAGNOSIS section, indicate whether you have been diagnosed with prostate cancer and provide details on tumor size and involvement of lobes.
Under TREATMENT, list any previous treatments you've undergone and select from available options for future treatment. Provide additional notes on side effects and prognosis as needed.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the 2 2 rule for prostate cancer?

2+2 rule must be applied to determine progression: During flare period: 2 new lesions on the 1st post-treatment scan + 2 additional new lesions on the subsequent scan with persistence of the original 2 lesions = progression.

Can you live 15 years with advanced prostate cancer?

15-year relative survival rate of 95 percent: Fifteen years after diagnosis, the average prostate cancer patient is 5 percent less likely to survive than a man without prostate cancer.