Centre No: RMH
Study Protocol Number: 2598
Ethics Protocol Number: 05/MRE07/25
Patient Identification Number for this trial:
Title of Project: Identification of Men with a genetic predisposition to ProstAte Cancer: Targeted screening in men at higher genetic risk and controls.
Name of Principal Investigator: Professor Ros Eeles
Please Initial Box
1. I confirm that I have read and understand the information sheet dated 12.11.2010 (version 1) for the above study and that I have had an opportunity to ask questions.
2. I am willing to continue participating in the above study
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Name of Patient Date Signature
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Name of Person obtaining consent Date Signature
(if different from Principal Investigator)
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Principal Investigator Date Signature
1 copy for Patient, 1 for Principal Investigator, 1 for Hospital Notes
5 year consent Version 2: 03.10.2012