madman
Super Moderator
What if your prostate biopsy is missing the most important detail? In this powerful episode, Dr. Geo sits down with Dr. Jonathan Epstein, one of the most influential urologic pathologists in the world, to break down what’s really happening behind your diagnosis.
From Gleason scores to hidden aggressive patterns, this conversation reveals why pathology is the foundation of every prostate cancer decision — and why getting it right is critical.
If you’ve had a biopsy, elevated PSA, or are considering treatment vs. surveillance… this episode is essential listening.
Key Takeaways
* Pathology is the foundation of your diagnosis — everything else depends on it
* Up to 20–30% of biopsy readings may change with expert review
* Not all prostate cancer is dangerous — but some “low-risk” cases hide more aggressive disease
* MRI and advanced imaging are powerful, but they can still miss cancer
* A second opinion on your biopsy can completely change your treatment plan
CHAPTERS
00:00 – The Hidden Problem With Prostate Biopsies Why your diagnosis may not tell the full story
09:00 – Why Gleason 6 Is So Controversial Should it even be called cancer?
15:30 – The Most Important Details in Your Report Cribriform patterns, intraductal cancer, and why they matter
23:00 – Why MRI and PSMA Scans Aren’t Perfect What imaging can miss
36:00 – How Often Pathology Is Wrong Why second opinions are critical
38:00 – The Problem Patients Don’t See You don’t know who’s reading your biopsy
45:00 – What Patients Should Do Next How to advocate for yourself
