National Cancer Institute - Cancer.gov

Urologic Oncology Branch Prostate Clinic

If you are looking for general information about prostate cancer, please explore the resources available here.

Also, you may visit CCR clinical trials to learn about some other options.

If you have any questions or have an issue filling out this form, please contact our team at 240-858-7200 or UOBProstateReferrals@mail.nih.gov.

This initial screening form is the first step in a multi-step process for being considered for participation in any screening, diagnosis, and treatment trials with the CCR Urologic Oncology Branch at the National Cancer Institute in Bethesda, Maryland. 

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Application Information
Contact Information
(mm/dd/yyyy)
Type of Phone?
Preliminary Questions
Have you received treatment for your Prostate Cancer?
Have you been diagnosed with metastatic disease?
Medical Information
Cardiac History
Any history of Stents, Pacemaker, Defibrillator, or A fib?
Imaging History
Have you had a MRI pelvis or prostate?
Bone Scan or CT of the Abdomen/Pelvis?
Are you claustrophobic?
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