Working to improve prostate cancer treatment outcomes
Dr. Bruce Dalkin is a urologic oncologist interested in health-related quality-of-life outcomes research.
“Twelve years ago I decided that I wanted to more accurately learn about what happens to people after surgery for prostate cancer, find out how well I was doing for my patients, and then be able to tell future patients what to truly expect,” Dr. Dalkin says. Working as an associate professor of surgery at the University of Arizona, he initiated a prospective quality-of-life survey study of his patients before and after surgery, and followed them for up to eight years. The surveys were completed anonymously by the participants, and the capture rate has been over 90 percent. “The interview questionnaire looked at things like sexual and urinary health – big issues for men after this type of surgery,” he says. The results of Dr. Dalkin’s research have been published in Urologic Oncology, Journal of Urology, and Cancer.
"Our field cheats at how we define success,” Dalkin says. “This study was an optimal way to find out if we really are doing well for our patients.”
Fortunately for him and his colleagues, the answer was yes. His patients fare very well after surgery, according to the study results. However, if they had not, modifications to treatment and/or surgical approaches would have been examined and refined.
A well-designed study will help improve medical care and outcomes, according to Dalkin. He would like to see all prostate cancer physicians participate in this sort of study, to accurately define the true outcomes of surgery, radiation therapy, and medical oncologic treatments “to better educate men on expected outcomes, and our treatment impact,” he says.
“It is likely that not all physician have equal outcomes, and if we can define the differences, then teach all to perform well, it would lead to more cost-effective outcome-based medicine, and better results for patients,” Dalkin says.
Coming to University of Washington Medical Center provides Dalkin with a larger patient volume from which to continue his research. He hopes to utilize a similar study here and define outcomes over the next three to five years.
“Robotic surgery has not been shown to have any advantages to well done open surgery with regards to recovery, urinary continence, and sexual health,” Dalkin says. “There have been some recent concerns about cancer control issues and robotic surgery. Also, we are lacking well-designed quality-of-life survey studies with robotic surgery, or to compare to high quality standard surgery,” Dalkin says. “Seattle is the perfect city to look at all the different surgeons and surgical techniques in a high quality study.”
A regional-based assessment would be ideal to define how urology and radiation oncology are doing for patients’ outcomes and quality of life.
Dalkin believes there have been few studies to date of this nature because “If you end up not being good, there’s a big problem, and it’s not good for patient referrals. But, our field needs to look beyond this concern, define what the problems are if they do exist, then define how to correct them if possible. This will eventually improve outcomes for all prostate cancer patients.”
Surveys in Dalkin’s study are completed anonymously by the patients and collected and tabulated by an independent third party.
“This is how quality-of-life outcomes research should be done,” Dalkin says. “We would all be better off, physicians and patients.”
Dr. Dalkin received his medical degree and residency training in general surgery and urology at Northwestern University in Chicago. He served as a urologic oncologist at the University of Arizona for 12 years, and the director of Urologic Oncology at the Arizona Cancer Center for seven years. He also worked in private practice in Tucson for six years prior to beginning his position at the University of Washington. His other research interests include treatment of men with low risk and high risk prostate cancer. Referrals can be made by calling (206) 598-6088 or 288-6542.
Read more about Dr. Dalkin's Outcomes Research Results.