Neil Fleshner

MD, MPH, FRCSC

Phone

(416) 946-4501 ext. 2899

Assistant(s)

Biography

Dr. Neil Fleshner is Chair and Professor at the Division of Urology, University of Toronto. Dr. Fleshner is certified in both urology and epidemiology. He earned his MPH degree from the School of Public Health at Columbia University and completed his oncology training at Memorial Sloan Kettering Cancer Center.

Dr. Fleshner is an avid music lover and father of three.

Areas of Specialty and Research Interests

Aside from surgical practice, Dr. Fleshner conducts research on urologic cancer prevention with an emphasis on prostate cancer. He has authored over 400 scientific papers. Dr. Fleshner's current research projects include 2 randomized trials of nutritional intervention in prostate cancer as well as laboratory work assessing oxidative biomarkers and cell cycle regulation in prostate cancer cells exposed to micronutrients.

Affiliated Hospital(s)

Mount Sinai Hospital, Princess Margaret Cancer Centre (UHN), Toronto General Hospital (UHN)
 
 

Latest Publications

Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic.

Related Articles

Propensity Score Analysis of Radical Cystectomy Versus Bladder-Sparing Trimodal Therapy in the Setting of a Multidisciplinary Bladder Cancer Clinic.

J Clin Oncol. 2017 Jul 10;35(20):2299-2305

Authors: Kulkarni GS, Hermanns T, Wei Y, Bhindi B, Satkunasivam R, Athanasopoulos P, Bostrom PJ, Kuk C, Li K, Templeton AJ, Sridhar SS, van der Kwast TH, Chung P, Bristow RG, Milosevic M, Warde P, Fleshner NE, Jewett MAS, Bashir S, Zlotta AR

Abstract
Purpose Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. Methods Data from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinoma in situ status, and hydronephrosis) with propensity scores to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox proportional hazards modeling and a competing risk analysis, respectively. Results A total of 112 patients with MIBC were included after matching (56 who had been treated with TMT, and 56 who underwent RC). The median age was 68.0 years, and 29.5% had stage cT3/cT4 disease. At a median follow-up of 4.51 years, there were 20 deaths (35.7%) in the RC group (13 as a result of BC) and 22 deaths (39.3%) in the TMT group (13 as a result of BC). The 5-year DSS rate was 73.2% and 76.6% in the RC and TMT groups, respectively ( P = .49). Salvage cystectomy was performed in 6 (10.7%) of 56 patients who received TMT. Conclusion In the setting of a MDBCC, TMT yielded survival outcomes similar to those of matched patients who underwent RC. Appropriately selected patients with MIBC should be offered the opportunity to discuss various treatment options, including organ-sparing TMT.

PMID: 28410011 [PubMed - indexed for MEDLINE]