Prostate Cancer Patient Consultation Form Page 3
ADVERTISEMENT
1
2
3_______ Watchful Waiting (monitored by physician)
_______ Other ____________________________________________
Do you recommend hormonal therapy prior to, or after, the treatment selected?
Yes: _____ No: _____
Why?
________________________________________________________________
_
What are the side-effects to the recommended treatment:?
incontinence:______________________________________________________
sexual dysfunction:
_______________________________________________________
other:
_______________________________________________________________
How many of these procedures have you done? ___ How frequently now? _____
What is the prognosis for
:
survival __________________________________________________________
recurrence ______________________________________________________
2nd opininon options:
Urological oncologist
_________________________________________________
- Radiation oncologist
__________________________________________________
- Medical (genito-urinary) oncologist
__________________________________________________
- Alternative/Complementary Medicine specialist
__________________________________________________
Notes: ___________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business