Prostate Cancer Risk Assessment Tool Step 1 of 11 9% Start Information Summary Name(Required)Date of birth(Required) MM slash DD slash YYYY GenderMaleUnspecifiedMobile Phone Start Information Summary Q1. Has your father, brother, or son ever been diagnosed with prostate cancer?(Required) Yes Not sure No Q2. Did any of your male relatives develop prostate cancer before age 60?(Required) Yes Not sure No Q3. Do two or more relatives on the same side of your family have any of the following cancers: prostate, breast, ovarian, pancreatic, colorectal, or uterine cancer?(Required) Yes Not sure No Q4. Has any man in your family had aggressive or metastatic (advanced) prostate cancer?(Required) Yes Not sure No Q5. Has any blood relative tested positive for a hereditary cancer gene (for example, BRCA1, BRCA2, ATM, CHEK2, HOXB13, or Lynch syndrome genes)?(Required) Yes Not sure No Q6. Do you have African or Caribbean ancestry?(Required) Yes Not sure No Q7. Do you have Ashkenazi Jewish ancestry?(Required) Yes Not sure No Q8. Have you ever had an elevated PSA level, an abnormal prostate MRI, or an abnormal prostate examination?(Required) Yes Not sure No Q9. Has any close family member (parent, sibling, or child) been diagnosed with any type of cancer before age 50?(Required) Yes Not sure No Q10. Have you had a blood transfusion in the last 14 days, received a donor bone-marrow or stem-cell transplant, or are you currently receiving treatment for a blood cancer?(Required) Yes Not sure No This field is hidden when viewing the formSummaryThis field is hidden when viewing the formQ10
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