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Progress Report: Thomas Guzzo, MD, MPH

Investigator: Thomas Guzzo, MD, MPH – Assistant Professor, University of Pennsylvania

Reducing Morbidity from Surgery and Physician Counseling of Treatment Costs

Dr. Guzzo has had a very prolific second year as a PCF Young Investigator as evidenced by his publication of ten scientific and clinical reports. His primary research aims are to identify methods of reducing morbidity from prostate cancer surgery and to identify patients who may have a higher risk of mortality following surgery.

In a retrospective study of 15,145 patients who underwent radical prostatectomy (RP), Dr. Guzzo determined the Charlson Comorbidity Index (CCI) for each patient. This is an extensively validated comorbidity scale that ranks the healthiest patients with a CCI value of 0 and the unhealthiest patients with a CCI of greater than 2. He found that high CCI values predicted for a greater likelihood of non-prostate cancer death after RP. These results suggest that physicians should counsel patients regarding overall morbidity when considering RP.

Since prostate tumors grow in bunches throughout the prostate, like grapes on a vine, it is difficult to biopsy. Some patients undergo repeat biopsies to ensure accurate pathological staging of the cancer. However, mounting evidence suggests that repeat biopsies do not result in increased detection of adverse pathology. Dr. Guzzo conducted a thorough retrospective study of 2,323 prostate cancer patients that underwent RP after 1, 2 or 3 biopsies to evaluate the incremental risk of clinically insignificant prostate cancer. Dr. Guzzo’s study results showed that patients who had 2 or 3 biopsies before RP had an increased risk of clinically insignificant disease. This suggests that one biopsy may be enough to detect clinically significant prostate cancer. Furthermore, since risk of infection or other side effects from biopsies are possible, Dr. Guzzo’s findings suggest that patients and physicians should consider all these factors before undertaking a repeat biopsy.

Dr. Guzzo’s research makes a tangible impact on patient-physician treatment decision-making. He is currently initiating a new study that will assess how treatment costs effect patient choices and whether physicians should play a role in counseling patients through the cost-benefit analysis of their different treatment options. In this study Dr. Guzzo aims to develop a process that estimates the range and magnitude of out-of-pocket expenses for various therapies for localized prostate cancer for individual patients. He will then test the cost intervention to identify if knowledge of out-of-pocket expenses changes treatment choice and treatment satisfaction.