Prostate Cancer

Prostate Cancer

Men over the age of 40 are at a higher risk of developing prostate cancer. Prostrate cancer is highly treatable if detected early. This questionnaire is designed to help you and your physician identify whether you are currently showing any signs of prostate problems. This questionnaire does not replace regular visits to your doctor for prostate screening but merely lists factors, which could be indicative of prostate problems.

Each question has several responses from which you are asked to choose the one that best describes your own situation. Please be sure that you select only one response per question.

Please ensure all information is completed correctly in order for us to respond to your assessment promptly.

Your Name (required):

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Over the past six months:


QUESTION 01:
Over the past month or so, how often have you had a sensation of not emptying your bladder completely after you finished urinating?

QUESTION 02:
Over the past month or so, how often have you had to urinate again less than two hours after you finished urinating?

QUESTION 03:
Over the past month or so, how often have you found that you stopped and started again several times when you urinated?

QUESTION 04:
Over the past month or so, how often have you found it difficult to postpone urination?

QUESTION 05:
Over the past month or so, how often have you had a weak urinary stream?

QUESTION 06:
Over the past month or so, how often have you had to push or strain to begin urination?

QUESTION 07:
Over the last month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning?


Submit your self assessment form to the Mens Clinic International Doctor for evaluation: