Jonathan Epstein, who literally wrote the guidelines for prostate cancer pathology, is now in private practice (he used to be affiliated with Johns Hopkins). He personally reads all prostate biopsies sent to him.
This was written by Harold Wolinsky on his blog:
"He charges a consultation fee of $450. Sign up for a consult here: advanceduropathology.com/co...
“For the time being, we don't have the process to direct bill patients, such that patients need to send consults through their physician or the laboratory that did the pathology, who we will bill and then will get passed on to the patient,” he said. For more information go to Advanced Uropathology at advanceduropathology.com/
He will be a consultant for all male genitourinary specimens and bladder cases in men and women. He will review consults in the prostate, bladder, kidney (non-medical diseases), urothelial tract (renal pelvis, ureter, bladder, urethra), penis, scrotum, and adrenal glands.
Castle Connolly, a peer-reviewed directory of medical providers, recognized Advanced Urology Centers of New York (a Division of IMP) as the #1 urology practice in the country. IMP has over 100 physicians and is part of Solaris Health ,which is a urology organization in 14 states with over 730 practitioners, seeing 1 million unique patients yearly.
“Some of the cases sent to me already have a diagnosis and either the patient or clinician wants my second opinion. Other cases are sent by pathologists where the diagnosis is uncertain and they want to know my diagnosis. In these latter cases, I provide my opinion, but the contributing pathologist still signs out the case as I am not the primary pathologist on the case. This is the reason why, for example, a specimen must first be processed in the laboratory affiliated with the patients’ clinician before being sent to me for a second opinion,” Epstein said.
In addition to his solo practice, Epstein is the primary anatomic pathologist diagnosing the vast majority of uropathology specimens for IMP.
“I will be the only pathologist diagnosing consults sent to the practice. This avoids the problem I had in the past where when I was out of the office and another pathologist covered my consults. In some cases, patients or clinicians requested I re-review the case when I came back to the office and when I disagreed with the covering pathologist it resulted in difficulties,” he said. “I don’t take many days off from work, and the longest I will be absent is five working days, such that there will not be a significant delay in reporting a case even when I am away. Patients and physicians sending consults to Advanced Uropathology of New York expect me to be the one looking at their case and without exception that will be the practice.”
Unless special stains are needed, only in a minority of cases, Epstein will issue a diagnosis within 24 hours. He recommends sending cases using expedited mail with tracking. He will return the slides within two weeks Fed Ex at his expense. The reason he waits for two weeks is if there is a question regarding the case, he will have have the slides available to review and discuss.
He expects to handle 30 cases per day. He will continue to counsel patients and, unlike most pathologists, will consult with patients and offer “qualified”recommendations on a course of treatment, such as Active Surveillance vs. more aggressive approaches.
Epstein said that as patients have a relationship with their clinician, they should ask the clinician to explain the pathology report. However, if the clinician does not adequately explain the report, then pathologists should be available to answer patient questions about their pathology report, he said.
“Almost all pathologists do not make recommendations for treatment. Because I have written about and are intimately involved with many of the urological diseases and their treatment, I will make ‘qualified’ recommendations. I use the term ‘qualified’ because I don’t know everything about the patient compared to the clinician, some of which could impact treatment for an individual patient that may differ from what would be the treatment for the typical patient,” he said.
However, there are certain pathological findings, such as intraductal carcinoma or large cribriform Gleason pattern 4, or 3+4=7 bordering on 4+3=7 which for the vast majority of patients would be a contraindication for active surveillance, and I would counsel a patient considering AS accordingly. Epstein said, “Whenever I discuss treatment options with a patient and/or their partner, I always add that they ultimately need to discuss with their clinicians. However, after patients or their partners have talked with me, they are more informed and can better discuss these issues with their clinicians.”
He said on a typical day, he expects he will consult with one or two patients per day. This is not typical in pathology practice.
Epstein, 67, is a native of Bangor, Maine, He attended college and medical school in Boston.
Epstein moved to the Big Apple after over 40 years at Johns Hopkins School of Medicine. He had a falling out with Hopkins and resigned in May 2023.
“I have always wanted to eventually live in NYC and when a great GU Pathology practice became available in the area. I was thrilled to move to the city. I live in the Flatiron District in the middle of Manhattan, and have loved every day here.
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