Uropathologist Epstein flying solo in brand-new New York City practice

Al Roker updates his PCa

(Dr. Jonathan Epstein, the famed uropathologist, spoke at The Active Surveillor’s webinar, Active Surveillance 2025: The Year In Review, on Jan. 4, 2023. He was relocating his practice to NYC and was not ready to share details on his new practice. Several patients wanted to know. If you watch the webinar video, please respond to the questionnaire: https://forms.gle/oJ2NTvaXtE9GuXH2A Epstein spills below.—Howard Wolinsky)

By Howard Wolinsky

World-renown uropathologist Jonathan Epstein, MD, has launched details about his new practice Advanced Uropathology of New York: Global Consultation Services in New York City.

Advanced Uropathology is affiliated with Integrated Medical Professionals, PLLC, (IMP) (https://www.imppllc.com/about-imp-2/), a subsidiary of Solaris Health. www.solarishealthpartners.com,.

He charges a consultation fee of $450. Sign up for a consult here: https://advanceduropathology.com/consultation/

“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 https://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.

(Dr. Jonathan Epstein, Advanced Uropathology , NYC.)

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. moreaggressive 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 over the telephone with one or two patients per day. This is rare 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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Promise DNA study reaching end to recruitment

If you have been diagnosed with prostate cancer and you want to spit for science and get a free germline test, you’d better hurry.

Christina Tran, MPH, senior project manager for Promise, told The Active Surveillor the study has about filled its quota. She said Promise has tested 4,377 men with prostate cancer across the U.S. “We are aiming to test 5,000 to identify 500 men with prostate cancer and germline mutations of interest.”

So sign up soon: prostatecancerpromise.org

MRI-invisible lesions and low-risk prostate cancer

Don’t miss this Jan. 25 webinar from Active Surveillance Patients on MRI-invisible lesions featuring pioneering researcher Dr. Mark Emberton, Professor of Interventional oncology at University College London and Dean of its Faculty of Medical Sciences.

Catch the video here: https://aspatients.org/meeting/mri-invisible-lesions-and-low-risk-prostate-cancer/

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Check out my new Substack newsletter Prostate Cores, abstracts on research on PCa, biopsies, BPH, prostatitis.

NBC meteorologist shares his PCa forecast

By Howard Wolinsky

In an interview with SurvivorNet, TODAY weatherman and prostate cancer survivor Al Roker, 67, shares his decision to undergo radical surgery, saying "I just want this out," when talking about his cancer.

"My first reaction was, 'I just want this out. I don't want to do radiation,'" Roker ssaid of the prostate cancer that was growing inside his body. "At the end of the day, I thought, 'surgery first,' then I thought, 'no, maybe radiation,' then I went back and (said), 'no, surgery.' That was that. Once I make a decision, I don't really second-guess it."

To his credit, Roker has made education about prostate cancer his mission, especially among Black men, who face higher rates of PCa than the general population.

[I wish high-profile men on Active Surveillance would follow his example.]

Roker was diagnosed with “aggressive” Gleason 7 in 2020.

He strongly advocates that men undergo PSA testing, which was what uncovered his cancer.