The Gentlemen Study Pre-Screening Survey

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Hello, and welcome to the GENTleMEN Study.

The goal of this study is to improve access to genetic services by providing free testing and counseling to men with advanced prostate cancer to see if they’ve inherited alterations in genes linked to this disease. Participants who are found to carry a mutation can share their results with their doctor and family members. They and will have access to genetic counseling by phone or face-to-face at Seattle Cancer Care Alliance.

To qualify for this study, participants must have a verified diagnosis of advanced prostate cancer, otherwise known as metastatic prostate cancer. This means that the prostate cancer has spread outside the prostate to distant parts of the body, e.g. bone or liver.

As a participant in this study, we will be asking you questions to help us learn about you and whether this is an effective way to deliver genetic services to men with prostate cancer.

Please try to answer as best you can.

If you would like to learn more about this study, please see this article.

TIPS BEFORE YOU START:
You will need to complete the questionnaire to proceed with the study. These questions should take about 40 minutes to complete.

You can ask a family member or friend to help you. You can also ask the study team for help.

Before you start, you may want to collect your medical information, records and, all the information you can collect about your family history of cancer: For example, which family members had cancer, how old they were when they were diagnosed, if they are still living or if cancer was a cause of death.

You can save your answers and come back to finish the questions later.
If you have questions while completing the study, you can call us at the toll-free number 877-606-GENT(4368) or email us at gentmen@uw.edu.

Your DATE of BIRTH

* must provide value

M-D-Y

I currently have metastatic prostate cancer.

* must provide value

True

False

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(Metastatic means the cancer has spread further outside of the prostate, such as to bone and/or lymph nodes. You can ask you doctor if you have this.) If you do not have metastatic prostate cancer or you are not able to provide complete information needed to meet eligibility requirements, you will not be be able to participate this study. If you are not eligible, we thank you for your interest and, we encourage you to look for other study opportunities.

This study is unable to process samples from patients that have a hematological malignancy and/or frequent* blood transfusions because they interfere with test results. Do either of these apply to you?

* must provide value

Yes

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Your First Name

* must provide value

Your Last Name

Your mailing address
(Street, City, State, ZIP)

* must provide value

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Your phone number

* must provide value

E-mail address

* must provide value

Please verify your E-mail address

* must provide value

How did you find out about the GENTleMEN study? Please select all that apply.

From my doctor or clinician

From a friend or support group member

From a news story, internet search or social media

From information sent by mail

Other

What was the website or information source?

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How did you hear about the GENTleMEN study?

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.