Pro Onco Study Performa

Prostate Onco Study Performa

Follow Up Date:

Name

Hospital Record ID(File No.):

CRPC/CSPC:

CRPC

CSPC

Labs

Labs Date

PSA Levels

Testosterone Levels

Plan

Disease Status:

Stable

Prograssive

Abiraterone Dose in mg

Dose Reduction:

Yes

No

Reason

Side effect Profile :

Side Effects :

Hypertension

Grade (I-IV):

Management:

Hyperglycemia

Grade (I-IV):

Management:

Electrolyte imbalances

Grade (I-IV):

Management:

Hepatotoxicity

Grade (I-IV):

Management:

Fatigue

Grade (I-IV):

Management:

Fluid retention

Grade (I-IV):

Management:

Anemia

Grade (I-IV):

Management:

Any Others:

Grade (I-IV):

Management:

Physician Name