Chinese and Western prostate cancers show alternate pathogenetic pathways in association with ERG status

We have previously reported genetic differences between Western and Chinese prostate cancers, including different frequencies of ERG rearrangements. We investigated further ERG expression and rearrangements in prostate cancers and high-grade prostatic intraepithelial neoplasia (HGPIN) from the UK and China to determine differences between these two populations by tissue microarray based immunohistochemistry and fluorescence in situ hybridization. In keeping with our previous observation, that ERG was rearranged at a higher frequency in UK prostate cancer samples (38%, 58/155) than Chinese ones (8%, 7/93), ERG rearrangements were also found in 21% (4/19) and 0% (0/19) foci of HGPIN in UK and Chinese samples respectively. ERG nuclear expression in UK cancers (34%, 54/160) was significantly higher than that in Chinese ones (10%, 9/88) (p<0.001). ERG nuclear expression in UK HGPIN (28%, 11/39) was higher than that in Chinese HGPIN (0%, 0/9), but without statistical significance (p=0.193). ERG nuclear expression was correlated to ERG rearrangements in both UK (Kappa=0.686) and Chinese (Kappa=0.565) cancers. These data demonstrate that ERG rearrangement and expression frequencies are different in prostate cancers from UK and China as early as the precursor lesion, HGPIN. The nuclear expression is associated with ERG rearrangements which mainly occur in the Western samples. UK and Chinese prostate cancers may be the result of different genetic mechanisms.