BASELINE SURVEY

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Dear Patient,

If you are a newly-diagnosed prostate cancer patient, we would like you to be part of an important research study. This study is being done to help us better understand the health outcomes of patients like you.

Prostate cancer has many available treatment options, each with a variety of potential benefits and harms. Doctors cannot recommend a single management approach for all individuals; rather, decisions about the management of prostate cancer are dependent on the preferences and values of each individual patient.

To improve the quality of care of prostate cancer patients, we need more information about the factors that are important to patients as they decide what treatments are best for them. We believe this kind of information can help your doctors understand your needs and take better care of you.

For this reason, we are asking patients like you to fill out a questionnaire that will take about 20 minutes of your time. The questionnaire will ask you about your overall health and well-being, your treatment decisions, and various beliefs and attitudes that might influence those decisions. It will also ask about your experiences with your medical care. We will ask you to fill out this questionnaire now, and a shorter questionnaire at later times in the future, as long as you are willing.

We believe this study will help improve the care of patients in the future, although at this time there are no direct benefits to you or your family. The risks of participating in the study are also very small, and we will take steps to minimize these risks. Some people do not like to discuss their feelings and opinions. You are therefore free to skip any questions you are not comfortable with. Some people are also concerned about privacy and confidentiality of a survey like this. We therefore take the following steps to ensure that your answers will be confidential:

· Your name will not be used on the answers you give us

· The information will not be shared with the doctors or staff who treat you

· The information will be entered into a secure database (along with information from other patients taking part in the study)

· Only the study researchers will be able to see the information

Being part of the study is voluntary—you are free not to take part in it. You may also leave the study at any time. Leaving the study will not result in any penalty or loss of any benefits.

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We hope that you participate in this important study. If you would like more information about the study, you may contact the following people by phone or by email by first selecting your location:

Maine New York

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~Dr. Paul Han, Principal Investigator - hanp@mmc.org, 207-661-7619
~Ms. Caitlin Gutheil, Research Coordinator - guthec@mmc.org, 207-661-7629
~Ms. Tracy Robbins, Clinical Research Nurse - robbit@mmc.org, (207) 396-8377
For questions about your rights as a research participant, contact the Maine Medical Center Institutional Review Board (a group of people who review the research to protect your rights) at (207) 396-8183.

~ Dr. Michael Diefenbach, Principal Investigator - Michael.Diefenbach@mountsinai.org, (212) 241-0751.
~ Matthew Hall, Research Coordinator - matt.hall@mountsinai.org.
For questions about your rights as a research participant, contact the Mount Sinai Hospital Institutional Review Board (a group of people who review the research to protect your rights) at (212) 824-8200.

Do you wish to continue with this study?

* must provide value

Yes No

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Please enter your name and date of birth below. This information will allow us to confirm that you are a patient at one of our study sites - Maine Medical Center Urology or Radiation Oncology or Mount Sinai Medical Center-New York . This information will be kept separately from your other survey answers, will remain anonymous and will not be linked to you as an individual.

First name

* must provide value

Last name

* must provide value

Date of birth

* must provide value

M-D-Y

Survey start date

* must provide value

M-D-Y

We also request your email address so that we may send you follow-up surveys in the future. Your participation in future surveys is not required, but will help us better understand the needs of our patients. We will not share your email address with anyone outside of this study.

Thank you for your consideration!

* must provide value

We are sorry you are not interested in participating at this time. The survey will only take 20 minutes and will help us better understand the needs and experiences of prostate cancer patients. If you are willing to participate, please click the "yes" button. If not, please tell us the primary reason you are unable to do so:

I do not have time

I am uncomfortable sharing my opinions

I am concerned about privacy

Other

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You have selected an option that triggers this survey to end right now.

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.