Prostate Cancer Knowledge and Awareness Level Survey Form

Gender:

Age:

Marital Status:

Educational Status:

Cities Where Education Was Given (more than one):

Income (TL) (… - 2500, 2500 - 5000, 5000 - …):

Number of Children (If you have):

Frequency of Newspaper Reading:

How many books do you read on average per year?

What is the incidence of prostate cancer in men?

Rare Frequent

In which age ranges is prostate cancer more common?

Children Young Adolescent Group Middle age Group Elderly

Can women get prostate cancer too?

Yes No

Do you know that the role of the prostate is to carry urine and contribute to the formation of semen?

Yes No

Prostate cancer can occur in men at any age.

True False

Did you know that prostate cancer may not show symptoms?

Yes No

In case of early diagnosis can prostate cancer be treated?

Yes No

Which of the following factors do you think increase the risk of prostate cancer?

Smoking Genetic Drinking less water

Alcohol Race Nutrition Environmental Factors

Have anyone of your close relative (father, uncle, sibling) prostate cancer?

Yes No

Did you know that individuals with a family history of prostate cancer have an increased risk of developing prostate cancer?

Yes No

Do you think regular sexual intercourse affects reducing the risk of prostate cancer?

Yes No

Is prostate cancer transmitted during sexual intercourse?

Yes No

How often do you think a man over 50 should have a prostate exam?

Never 1 time in 2 years 1 time in 5 years 1 time per year 1 time in 3 years I don’t know

Do you think that a rectal examination is the only diagnostic method for prostate cancer?

Yes No

What is the source of information about curability of prostate cancer if diagnosed at an early stage?

Television Doctor/Nurse Radio Newspaper Scientific Publications Friend/Relative

*** Questions to be asked if the individual is male:

Have you ever been to the urology outpatient clinic?

Yes No

Are you planning to go?

Yes No

Have you had any medical tests for prostate within the last 5 years?

Yes No

Are you afraid of the prostate examination?

Yes No

*** If yes, why?:

It is said that standing to urinate has a negative effect on1 prostate cancer. Do you think this is true?

Yes No