Urologic Pathology

The Urologic Pathology Laboratory is a nationally recognized center for the study of urologic disorders. We are known in particular for our vast expertise in the study and diagnosis of the pathology of prostate cancer. We consult with pathologists and clinicians throughout the United States as well as overseas, reviewing as many as 15,000 cases a year. Because of this extensive experience, we can provide accurate diagnoses and second opinions as well as sound recommendations for treatment management.


The Urological Pathology Consult Division was established in the mid-1980s when Dr. Jonathan Epstein joined the staff at The Johns Hopkins Hospital. In addition to our unparalleled volume of consult work with prostate needle biopsies, division staff sees more than 1000 radical prostatectomies yearly. Our experience in evaluating these specimens helps physicians predict patient prognosis following radical prostatectomy.

We also provide valuable support to pathologists and physicians in the form of second opinions. Our expert evaluation can provide a more accurate grading of malignancies, enabling clinicians to treat their patients more effectively. A recent study demonstrates the utility of second opinion -- despite confidence in the initial diagnosis: For 1% of men coming to Hopkins for radical prostatectomies, our second opinion review reversed the diagnosis of cancer made outside this hospital and saved these men from major surgery.

Indicative of Dr. Epstein's interest and expertise in all aspects of urologic pathology are his books on Prostate Biopsy Interpretation and Bladder Biopsy Interpretation. He is also an editor of the World Health Organization (WHO) book on WHO Classification of Tumours : Pathology and Genetics. Tumours of the Urinary and Male Reproductive System. Dr. Epstein was the leading author on The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma and The World Health Organization/International Society of Urological Pathology Consensus Classification of Urothelial (Transitional Cell) Neoplasms of the Urinary Bladder.


Expert Consultation
Jonathan Epstein, M.D. Dr. Jonathan Epstein, a recognized leader in the field of urological pathology, is the division's primary consultant. He was one of the first investigators to develop a methodical approach to diagnosing limited adenocarcinoma of the prostate on needle biopsy. He lectures widely in the United States and overseas on urological pathology, with emphasis on prostatic and bladder disease, and has written several books and more than 700 articles.

In addition to his expertise in pathology, Dr. Epstein is knowledgeable about various treatment options for prostatic disease. He consults frequently with pathologists, referring physicians and patients about treatment management options.

Andres Matoso, M.D. In addition, Dr. Andres Matoso completed residency training in Urology and in Pathology followed by fellowship training in Urologic Pathology under the mentorship of Dr. Jonathan Epstein. An author of more than 35 papers and two book chapters, Dr. Matoso has received a number of awards for his work, including the Stowell-Orbison Award from the United States and Canadian Academy of Pathology.

Special capabilities and services
We perform stains off paraffin blocks as well as by destaining the H&E section and staining a portion of the H&E slide.

Timely Results

Written reports of results are faxed to contributors within 24 to 48 hours. When requested, Dr. Epstein talks to physicians and patients to discuss the results and recommendations for treatment management.


Interpretations of urological pathology specimens are provided by experienced specialists

Standard Specimen Processing
The laboratory provides expert evaluation of urological pathology specimens, using light microscopy with immunohistochemistry and/or electron microscopy as appropriate for each case. Studies can be done on tissue or on blocks of slides prepared elsewhere.


Light microscopy (LM)

Immunohistochemistry - Triple cocktail stain for HMWCK/p63/AMACR, others as needed

Turnaround time is routinely 24 to 48 hours. Slides sent for consultation are returned automatically to contributors within two weeks.