Anticancer research · 2026
Paired-sample Analysis of ERG Expression and TMPRSS2-ERG Fusion in Treatment-induced Neuroendocrine Prostate Cancer.
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Watanabe Ryuta, Shigehisa Ryu, Kawada Tatsushi, Yamamoto Shinkuro, Katayama Satoshi, Takamoto Atsushi, Nishimura Kenichi, Miura Noriyoshi, Araki Motoo, Inoue Keiji, Saika Takashi, Chu-shikoku Japan Urological Consortium (CsJUC) Research Collaboration
Аннотация
BACKGROUND/AIM: Prostate cancer is one of the most common malignancies in men. Although androgen deprivation therapy (ADT) offers substantial benefit, resistance to androgen signaling ultimately develops, leading to castration-resistant prostate cancer (CRPC). Approximately 10-17% of CRPC cases evolve into treatment-induced neuroendocrine prostate cancer (t-NEPC), an aggressive, androgen receptor (AR)-independent subtype. The TMPRSS2-ERG fusion gene is among the most frequent genomic alterations in prostate cancer; however, its involvement in t-NEPC development remains unclear.
PATIENTS AND METHODS: We retrospectively analyzed nine Japanese cases of t-NEPC diagnosed across multiple institutions. Immunohistochemical staining for AR and ERG and RT-PCR for TMPRSS2-ERG fusion gene expression were performed on paired adenocarcinoma and t-NEPC samples. Clinical data - including prostate specific antigen levels, Gleason scores, metastatic patterns, and outcomes - were compared between ERG-positive and ERG-negative groups.
RESULTS: ERG-positive prostate cancer was found in three of nine cases (33.3%), all of which were AR-positive, indicating that active AR signaling is required for TMPRSS2-ERG expression. ERG positivity was not clearly associated with prognosis or drug sensitivity, but time to NEPC differentiation tended to be shorter in ERG-positive cases. Only the e1e4 isoform of TMPRSS2-ERG was detected, while e2e4 was absent.
CONCLUSION: This study highlights heterogeneity in TMPRSS2-ERG fusion dynamics during t-NEPC evolution and suggests a potential association between ERG expression and earlier NE differentiation. This study provides a rare opportunity to analyze paired pre- and post-NEPC tissues, offering valuable insight into the relationship between ERG and TMPRSS2-ERG fusion gene expression and clinical parameters.
PATIENTS AND METHODS: We retrospectively analyzed nine Japanese cases of t-NEPC diagnosed across multiple institutions. Immunohistochemical staining for AR and ERG and RT-PCR for TMPRSS2-ERG fusion gene expression were performed on paired adenocarcinoma and t-NEPC samples. Clinical data - including prostate specific antigen levels, Gleason scores, metastatic patterns, and outcomes - were compared between ERG-positive and ERG-negative groups.
RESULTS: ERG-positive prostate cancer was found in three of nine cases (33.3%), all of which were AR-positive, indicating that active AR signaling is required for TMPRSS2-ERG expression. ERG positivity was not clearly associated with prognosis or drug sensitivity, but time to NEPC differentiation tended to be shorter in ERG-positive cases. Only the e1e4 isoform of TMPRSS2-ERG was detected, while e2e4 was absent.
CONCLUSION: This study highlights heterogeneity in TMPRSS2-ERG fusion dynamics during t-NEPC evolution and suggests a potential association between ERG expression and earlier NE differentiation. This study provides a rare opportunity to analyze paired pre- and post-NEPC tissues, offering valuable insight into the relationship between ERG and TMPRSS2-ERG fusion gene expression and clinical parameters.