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Prostate Cancer Monitoring Log

Personal PSA and Treatment Tracking Sheet

Oncology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________________ Date of Diagnosis: ______________ Medical Record #: ______________

PSA Tracking

Date PSA Level (ng/mL) Notes

Treatment History

Medications

  • Current Medications:
    • Name: _____________ Dose: _______ Start Date: _______
    • Name: _____________ Dose: _______ Start Date: _______

Procedures/Treatments

  • Type: ________________ Date: _______ Provider: _______
  • Follow-up Date: _______

Symptoms Log

Rate severity 1-10 (10 being most severe)

  • Urinary Issues:

    • Frequency: ___/10
    • Urgency: ___/10
    • Difficulty urinating: ___/10

  • Pain:

    • Location: ____________
    • Intensity: ___/10

Appointments

Date Provider Purpose Notes

Questions for Healthcare Team

Emergency Contacts

Oncologist: ___________________ Phone: ____________ Urologist: ____________________ Phone: ____________

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