Dr. Fleshner's clinical practice is in urologic oncology with research interests in prostate and bladder cancer.
Neil E Fleshner, MPH, MD, FRCSC
Clinician Investigator, Princess Margaret Cancer Centre
Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre
McCain Genitourinary Biobank
Study Status: Active
Study Purpose: To store samples from healthy volunteers and patients with genitourinary (GU) problems for future research. Samples will be used to help researchers find better ways to understand, treat and possibly find a cure to these problems.
Background: Biobanks are libraries where samples such as Blood, Urine and/or Tissue are stored. Storing samples ahead of time and making those samples available for scientists saves a lot of time. This improves research and helps scientiests to learn more about GU health problems that affect the bladder, kidneys, prostate, penis and testes. The samples are used to help find new ways to treat diseases.
Study Methods: The McCain Genitourinary Biobank collects blood, urine and/or tissue samples to store for future research along with health information (eg. age, ethnicity, etc.) about the patients who donated the samples. It can be a one-time collection or multiple collections over time. Researchers must apply and get approval to use the samples and health information. The samples are then used by researchers for a variety of research studies.
Health Conditions: Cancer
External Links:
https://mccaingubiobank.ca/
https://mccaingubiobank.ca/
MAST Study (Metformin Active Surveillance Trial)
Study Status: Completed
Study Purpose: The goal of the MAST trial was to see whether Metformin, a drug commonly used to treat diabetes, could slow prostate cancer in patients with low-risk disease.
Background: Prostate cancer is the most common cancer in Canadian men, with an 18% lifetime risk of diagnosis. Some patients have small, slow-growing, “low risk”, tumours that are unlikely to spread. These tumours do not require traditional therapies (radiation, surgery, chemo), which are known to cause significant and permanent side-effects. Knowing this, doctors encourage the use of “active surveillance”, which requires patients to be regularly screened (blood tests, biopsies, and digital rectal exams) to monitor the tumour. If the screening tests reveal a change in the tumour, more treatment would be offered.
Study Methods: Patients from 12 hospitals across Canada were invited to join the MAST trial. Patients who enrolled in the trial all had low-risk prostate cancer and were being monitored using active surviellance . Patients were randomly assigned a placebo (fake drug) or metformin, and asked to take the pills for 3 years. During this time, patients would continue regular screening for prostate cancer at their local hospital so that their tumours could be monitored for any changes.
Key Findings: The recruitment for MAST was completed in early 2024 and the research team is in the process of analysing the data and looking into why some patients had tumours that changed while others didn’t. So far, the team has found that metformin did not prevent low-risk tumours from getting worse. The research team is interested in looking at whether it is possible to predict how a tumour may change when a patient begins active surviellance.
Men with low-risk prostate cancer rely on active surveillance to monitor disease. This can prevent harm from unnecessary treatment. More strategies are needed to control low-risk tumours that have minimal side effects. Importantly, Metformin does not prevent the progression of low-risk prostate cancer suitable for active surveillance.
Health Conditions: Cancer
Empowering patients through personalized digital health: Designing a platform for monitoring genetic test results
Study Status: Completed
Study Purpose: To find out if people who had or were interested in genetic testing wanted a health tool that can give them regularly updated information on their cancer risk.
Background: Right now, doctors can’t fully use genetic testing because there isn’t enough information about how some genetic results can affect patients’ health. This missing information can make patients worried and prevent doctors from giving the most appropriate treatments.
Study Methods: People who agreed to be contacted for research were emailed an online survey to fill out.
Key Findings: Most people wanted a health tool that gives regular updates about their genetic cancer risk and to participate in research related to their data. They were also willing to help design the health tool by filling out surveys and giving feedback.
A health tool that gives regular updates can help ease worries about genetic cancer risk and help research by finding patients who meet specific genetic criteria.
Health Conditions: Cancer,Genetics
Bringing prostate cancer screening to those who need it most
Study Status: Active
Study Purpose: Men in the Black community are 70-80% more likely to develop prostate cancer, and more likely to die from it than others. This health disparity can be attributed to social and biological factors, including access to healthcare, lifestyle, and ancestry.
Background: Prostate cancer is the most common cancer among men in Canada. It is also the third leading cause of death in Canadian men. Additionally, current clinical guidelines for prostate cancer screening do not provide guidance for managing the higher rates of prostate cancer in Black men.
In general, screening guidelines provided by prostate cancer experts recommend routine PSA screening for men aged 55-69 years. PSA screening is a simple blood test in which the levels of the PSA protein produced by the prostate are measured. Higher levels can be related to the presence of prostate cancer and be used to initiate additional testing. In underserved Black communities there is a lack of screening. This results in delayed diagnosis of prostate cancer and delayed detection of more severe cases.
Study Methods: Dr. Fleshner and the UHN team, work in collaboration with The Walnut Foundation, a prostate cancer support group working with the black community. They have created an opportunity to provide direct access to PSA blood testing in underserved communities: the PSA Detect & Protect Outreach Clinic. UHN provides free PSA blood testing, while The Walnut Foundation creates a comfortable, safe, supportive environment. So far, the team has hosted successful events at community health centres in the greater Toronto area
Key Findings: This has brought testing to 230 men, out of which 22% (51 men) required follow-up. The team provides follow-up support to ensure that these men are able to receive subsequent testing and care that they need.
Health Conditions: Cancer
Shared decision-making for men with BRCA2 mutations considering removal of their prostate in the absence of any disease
Study Status: Active
Study Purpose: This study aims to develop a “decision aid”. The decision aid will assist patients who have a BRCA2 genetic mutation in deciding between prostate surgery versus monitoring options with their urologist.
Background: Men with the BRCA2 gene are at risk of developing prostate cancer. These patients need to decide between having their prostate removed or monitoring their prostate health. Patient decisions aids have been effective in many other diseases to improve decision-making between patients and doctors. Decision aids present all current known information about a disease, all available treatment options and facts about treatment outcomes.
Study Methods: A total of 10 patients will be enrolled in this study. Eligible patients include those that have a known BRCA2 genetic mutation and are considering removing their prostate despite the absence of disease. Participation involves the completion of a 10-question survey on your opinions regarding the developed decision aid. An option to receive the decision aid and complete the survey online is available via email.
Health Conditions: Cancer
Clinician Investigator, Princess Margaret Cancer Centre
Cancer Clinical Research Unit (CCRU), Princess Margaret Cancer Centre
Martin Barkin Chair, Division of Urology, Department of Surgery, University of Toronto
Professor, Department of Surgery, University of Toronto