Joseph A Costa, DO

My research efforts are mainly based upon the clinical outcomes. My more recent focus is on men receiving Proton therapy for prostate cancer. Reporting on this relatively new modality in collaboration with the Proton Center at UF has allowed for the publication of multiple topics. My main interest is the impact of Proton therapy on voiding function and sometimes dysfunction as well as the sexual side effects of such therapy. Prostate cancer is the most common cancer in men. Five-year survival, however, is 98% according to the National Institute of Health. All therapeutic interventions for prostate cancer carry risk and have some impact on a patient’s quality of life after treatment. Accurate publication of outcomes is the corner stone to becoming a credible resource for other institutions. The close relationship with physicians of the Proton Center, led by Dr. Nancy Mendenhall, is one of trust and complete confidence in the data reviewed. It has allowed for a productive series of publications describing the impact of therapy as well as side effects. The Proton Center is one of the most prestigious and highest volume centers in the nation. As such we have reported in 2014 on a review of the rise of systemic bacterial infections in men after biopsy or marker placement by the transrectal route. In 2016 we published further on the topic including ways to prevent significant post marker placement infection by first performing pre-procedure rectal cultures and specifically identifying resistant bacteria which would be cause for a change in antibiotic regimen. Post-procedural sepsis (systemic infection due to seeding of bacteria in the blood stream) carries the risk of serious morbidity and in some cases may result in death. The incidence of post prostate biopsy sepsis ranges from 0.67%-18% when reviewing multiple reports. Although most institutions do not experience double digit rates of sepsis, there is a consensus that the incidence is on the rise due to increasing resistance to fluoroquinolone antibiotics. Ciprofloxacin and Levofloxacin have been the main stay prophylactic antibiotics since the late 1980’s. The broad coverage of bacteria, ease of dosing orally, and excellent bioavailability make them ideal. The conclusions and specific recommendations made based upon clinical data from our review were: 1. Perform rectal culture and sensitivity tests prior to biopsy, 2. empirically change antibiotics when necessary and use the culture results to direct therapy, 3. Consider a transperineal rather than transrectal approach for biopsy or marker placement. In May of 2018 we published on the impact of pre-procedural rectal culture and sensitivity on our population of men. From 2015-2017 412 men were treated for prostate cancer in the Proton Center. Pre-procedural rectal cultures were obtained and directed antibiotic prophylaxis was performed for each procedure. The incidence of sepsis in our population was 0.2% Other quality of life outcome measures reported in regard to Proton therapy for prostate cancer are the negative impact of prior transurethral resection of the prostate on men’s quality of life after proton therapy when compared to a control group. Numerous publications have been made regarding the impact of proton on testosterone levels. I continue to follow and report on interventions for spinal cord injured patients suffering from neuropathic voiding dysfunction. One publication was of a novel approach to patients with bladder calculi and neuropathic voiding dysfunction. These patients often have large stones and are can have difficult surgical access due to prior injuries. Using careful imaging review these patients can be approached percutaneously which results in effective stone treatment and expedited recovery. I also was the principle investigator and first author on a study that was prospective randomized trial on catheter type and length preferences in men who empty their own bladder by self-catheterization. I will be meeting with a company that manufactures catheters and wants to perform a similar catheter preference study this week. This will also be a multi-institutional randomized study.