Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Prostate cancer in Jordanian-Arab population: ERG status and relationship with clinicopathologic characteristics

  • 227 Accesses

  • 2 Citations


TMPRSS2/ERG fusion was found to be the most common genetic event in prostate adenocarcinoma. There is a strong correlation between the fusion and ERG-positive immunostaining. Many studies showed racial variation in ERG expression in prostate cancer patients. There is no data however on the rate of ERG-positive cancer in Jordanian or Arab population. We evaluated the frequency and the significance of ERG fusion in Jordanian-Arab population using immunohistochemistry for ERG. The cohort included 193 prostate cancer specimens: 109 needle core biopsies, 45 radical prostatectomies, 37 transurethral resections of prostate, and 2 enucleation specimens. We found ERG reactivity in 64 (33.2%) of evaluated cases. The observed ERG frequency in the Jordanian-Arab population is lower than the one documented in North America, but it is higher than in Asian patient cohorts. The ERG positivity was significantly associated with lower baseline prostate-specific antigen but was unrelated to patient age, Gleason Score, or the novel Gleason Grade Groups. In the 45 prostatectomy cases, ERG did not correlate with the pathologic stage, margin, nodal status, and the biochemical recurrence, and it did not appear to represent an important prognosticator.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90. doi:10.3322/caac.20107

  2. 2.

    Gronberg H (2003) Prostate cancer epidemiology. Lancet (London, England) 361(9360):859–864. doi:10.1016/s0140-6736(03)12713-4

  3. 3.

    Alghamidi IG, Hussain II, Alghamdi MS, El-Sheemy MA (2014) The incidence rate of prostate cancer in Saudi Arabia: an observational descriptive epidemiological analysis of data from the Saudi Cancer Registry 2001–2008. Hematology/oncology and stem cell therapy 7(1):18–26. doi:10.1016/j.hemonc.2013.10.001

  4. 4.

    Hilal L, Shahait M, Mukherji D, Charafeddine M, Farhat Z, Temraz S, Khauli R, Shamseddine A (2015) Prostate cancer in the Arab world: a view from the inside. Clinical genitourinary cancer 13(6):505–511. doi:10.1016/j.clgc.2015.05.010

  5. 5.

    Mao X, Yu Y, Boyd LK, Ren G, Lin D, Chaplin T, Kudahetti SC, Stankiewicz E, Xue L, Beltran L, Gupta M, Oliver RT, Lemoine NR, Berney DM, Young BD, Lu YJ (2010) Distinct genomic alterations in prostate cancers in Chinese and Western populations suggest alternative pathways of prostate carcinogenesis. Cancer Res 70(13):5207–5212. doi:10.1158/0008-5472.can-09-4074

  6. 6.

    Lee K, Chae JY, Kwak C, Ku JH, Moon KC (2010) TMPRSS2-ERG gene fusion and clinicopathologic characteristics of Korean prostate cancer patients. Urology 76 (5):1268.e1267-1213. doi:10.1016/j.urology.2010.06.010

  7. 7.

    Statistics and indicators (2012) Ministry of Health http://www.moh.gov.jo/Pages/viewpage.aspx?pageID=177

  8. 8.

    Tomlins SA, Rhodes DR, Perner S, Dhanasekaran SM, Mehra R, Sun XW, Varambally S, Cao X, Tchinda J, Kuefer R, Lee C, Montie JE, Shah RB, Pienta KJ, Rubin MA, Chinnaiyan AM (2005) Recurrent fusion of TMPRSS2 and ETS transcription factor genes in prostate cancer. Science (New York, NY) 310(5748):644–648. doi:10.1126/science.1117679

  9. 9.

    Magi-Galluzzi C, Tsusuki T, Elson P, Simmerman K, LaFargue C, Esgueva R, Klein E, Rubin MA, Zhou M (2011) TMPRSS2-ERG gene fusion prevalence and class are significantly different in prostate cancer of Caucasian, African-American and Japanese patients. Prostate 71(5):489–497. doi:10.1002/pros.21265

  10. 10.

    Clark J, Merson S, Jhavar S, Flohr P, Edwards S, Foster CS, Eeles R, Martin FL, Phillips DH, Crundwell M, Christmas T, Thompson A, Fisher C, Kovacs G, Cooper CS (2007) Diversity of TMPRSS2-ERG fusion transcripts in the human prostate. Oncogene 26(18):2667–2673. doi:10.1038/sj.onc.1210070

  11. 11.

    Dong J, Xiao L, Sheng L, Xu J, Sun ZQ (2014) TMPRSS2:ETS fusions and clinicopathologic characteristics of prostate cancer patients from Eastern China. Asian Pacific journal of cancer prevention : APJCP 15(7):3099–3103

  12. 12.

    Jiang H, Mao X, Huang X, Zhao J, Wang L, Xu J, Zhang H, Lu Y, Yu Y (2016) TMPRSS2:ERG fusion gene occurs less frequently in Chinese patients with prostate cancer. Tumour biology : the journal of the International Society for Oncodevelopmental Biology and Medicine 37(9):12397–12402. doi:10.1007/s13277-016-5116-9

  13. 13.

    Miyagi Y, Sasaki T, Fujinami K, Sano J, Senga Y, Miura T, Kameda Y, Sakuma Y, Nakamura Y, Harada M, Tsuchiya E (2010) ETS family-associated gene fusions in Japanese prostate cancer: analysis of 194 radical prostatectomy samples. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 23(11):1492–1498. doi:10.1038/modpathol.2010.149

  14. 14.

    Furusato B, van Leenders GJ, Trapman J, Kimura T, Egawa S, Takahashi H, Furusato M, Visakorpi T, Hano H (2011) Immunohistochemical ETS-related gene detection in a Japanese prostate cancer cohort: diagnostic use in Japanese prostate cancer patients. Pathol Int 61(7):409–414. doi:10.1111/j.1440-1827.2011.02675.x

  15. 15.

    Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL (2005) The 2005 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma. Am J Surg Pathol 29(9):1228–1242

  16. 16.

    Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA (2016) The 2014 International Society of Urological Pathology (ISUP) consensus conference on Gleason grading of prostatic carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol 40(2):244–252. doi:10.1097/pas.0000000000000530

  17. 17.

    Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen C, Thrasher JB, Thompson I (2007) Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. The Journal of urology 177 (2):540–545. doi:10.1016/j.juro.2006.10.097

  18. 18.

    Watanabe M, Nakayama T, Shiraishi T, Stemmermann GN, Yatani R (2000) Comparative studies of prostate cancer in Japan versus the United States. A review Urologic oncology 5(6):274–283

  19. 19.

    Ahmad MM, Dardas LA, Ahmad H (2015) Cancer prevention and care: a national sample from Jordan. Journal of cancer education : the official journal of the American Association for Cancer Education 30(2):301–311. doi:10.1007/s13187-014-0698-7

  20. 20.

    Shahait M, Mukherji D, Yacoubian A, Shamseddine A, Khauli R (2014) S151: inter-regional variability of prostate cancer incidence and mortality rates in the MENA region. Eur Urol Suppl 13(7):e1506. doi:10.1016/S1569-9056(14)61707-3

  21. 21.

    Park K, Dalton JT, Narayanan R, Barbieri CE, Hancock ML, Bostwick DG, Steiner MS, Rubin MA (2014) TMPRSS2:ERG gene fusion predicts subsequent detection of prostate cancer in patients with high-grade prostatic intraepithelial neoplasia. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32(3):206–211. doi:10.1200/jco.2013.49.8386

  22. 22.

    Falzarano SM, Zhou M, Carver P, Tsuzuki T, Simmerman K, He H, Magi-Galluzzi C (2011) ERG gene rearrangement status in prostate cancer detected by immunohistochemistry. Virchows Archiv : an international journal of pathology 459(4):441–447. doi:10.1007/s00428-011-1128-4

  23. 23.

    van Leenders GJ, Boormans JL, Vissers CJ, Hoogland AM, Bressers AA, Furusato B, Trapman J (2011) Antibody EPR3864 is specific for ERG genomic fusions in prostate cancer: implications for pathological practice. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 24(8):1128–1138. doi:10.1038/modpathol.2011.65

  24. 24.

    Hoogland AM, Jenster G, van Weerden WM, Trapman J, van der Kwast T, Roobol MJ, Schroder FH, Wildhagen MF, van Leenders GJ (2012) ERG immunohistochemistry is not predictive for PSA recurrence, local recurrence or overall survival after radical prostatectomy for prostate cancer. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 25(3):471–479. doi:10.1038/modpathol.2011.176

  25. 25.

    Xu B, Chevarie-Davis M, Chevalier S, Scarlata E, Zeizafoun N, Dragomir A, Tanguay S, Kassouf W, Aprikian A, Brimo F (2014) The prognostic role of ERG immunopositivity in prostatic acinar adenocarcinoma: a study including 454 cases and review of the literature. Hum Pathol 45(3):488–497. doi:10.1016/j.humpath.2013.10.012

  26. 26.

    Schaefer G, Mosquera JM, Ramoner R, Park K, Romanel A, Steiner E, Horninger W, Bektic J, Ladurner-Rennau M, Rubin MA, Demichelis F, Klocker H (2013) Distinct ERG rearrangement prevalence in prostate cancer: higher frequency in young age and in low PSA prostate cancer. Prostate Cancer Prostatic Dis 16(2):132–138. doi:10.1038/pcan.2013.4

  27. 27.

    Pettersson A, Graff RE, Bauer SR, Pitt MJ, Lis RT, Stack EC, Martin NE, Kunz L, Penney KL, Ligon AH, Suppan C, Flavin R, Sesso HD, Rider JR, Sweeney C, Stampfer MJ, Fiorentino M, Kantoff PW, Sanda MG, Giovannucci EL, Ding EL, Loda M, Mucci LA (2012) The TMPRSS2:ERG rearrangement, ERG expression, and prostate cancer outcomes: a cohort study and meta-analysis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology 21(9):1497–1509. doi:10.1158/1055-9965.epi-12-0042

  28. 28.

    Minner S, Enodien M, Sirma H, Luebke AM, Krohn A, Mayer PS, Simon R, Tennstedt P, Muller J, Scholz L, Brase JC, Liu AY, Schluter H, Pantel K, Schumacher U, Bokemeyer C, Steuber T, Graefen M, Sauter G, Schlomm T (2011) ERG status is unrelated to PSA recurrence in radically operated prostate cancer in the absence of antihormonal therapy. Clinical cancer research : an official journal of the American Association for Cancer Research 17(18):5878–5888. doi:10.1158/1078-0432.ccr-11-1251

  29. 29.

    Esgueva R, Perner S, C JL, Scheble V, Stephan C, Lein M, Fritzsche FR, Dietel M, Kristiansen G, Rubin MA (2010) Prevalence of TMPRSS2-ERG and SLC45A3-ERG gene fusions in a large prostatectomy cohort. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 23 (4):539–546. doi:10.1038/modpathol.2009.193

  30. 30.

    Verdu M, Trias I, Roman R, Rodon N, Garcia-Pelaez B, Calvo M, Dominguez A, Banus JM, Puig X (2013) ERG expression and prostatic adenocarcinoma. Virchows Archiv : an international journal of pathology 462(6):639–644. doi:10.1007/s00428-013-1415-3

  31. 31.

    Fine SW, Gopalan A, Leversha MA, Al-Ahmadie HA, Tickoo SK, Zhou Q, Satagopan JM, Scardino PT, Gerald WL, Reuter VE (2010) TMPRSS2-ERG gene fusion is associated with low Gleason scores and not with high-grade morphological features. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 23(10):1325–1333. doi:10.1038/modpathol.2010.120

  32. 32.

    Szasz AM, Majoros A, Rosen P, Srivastava S, Dobi A, Szendroi A, Kulka J, Nyirady P (2013) Prognostic potential of ERG (ETS-related gene) expression in prostatic adenocarcinoma. Int Urol Nephrol 45(3):727–733. doi:10.1007/s11255-013-0406-2

  33. 33.

    Furusato B, Tan SH, Young D, Dobi A, Sun C, Mohamed AA, Thangapazham R, Chen Y, McMaster G, Sreenath T, Petrovics G, McLeod DG, Srivastava S, Sesterhenn IA (2010) ERG oncoprotein expression in prostate cancer: clonal progression of ERG-positive tumor cells and potential for ERG-based stratification. Prostate Cancer Prostatic Dis 13(3):228–237. doi:10.1038/pcan.2010.23

  34. 34.

    Attard G, Clark J, Ambroisine L, Fisher G, Kovacs G, Flohr P, Berney D, Foster CS, Fletcher A, Gerald WL, Moller H, Reuter V, De Bono JS, Scardino P, Cuzick J, Cooper CS (2008) Duplication of the fusion of TMPRSS2 to ERG sequences identifies fatal human prostate cancer. Oncogene 27(3):253–263. doi:10.1038/sj.onc.1210640

  35. 35.

    Mehra R, Tomlins SA, Shen R, Nadeem O, Wang L, Wei JT, Pienta KJ, Ghosh D, Rubin MA, Chinnaiyan AM, Shah RB (2007) Comprehensive assessment of TMPRSS2 and ETS family gene aberrations in clinically localized prostate cancer. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 20(5):538–544. doi:10.1038/modpathol.3800769

  36. 36.

    Mosquera JM, Mehra R, Regan MM, Perner S, Genega EM, Bueti G, Shah RB, Gaston S, Tomlins SA, Wei JT, Kearney MC, Johnson LA, Tang JM, Chinnaiyan AM, Rubin MA, Sanda MG (2009) Prevalence of TMPRSS2-ERG fusion prostate cancer among men undergoing prostate biopsy in the United States. Clinical cancer research : an official journal of the American Association for Cancer Research 15(14):4706–4711. doi:10.1158/1078-0432.ccr-08-2927

  37. 37.

    Saramaki OR, Harjula AE, Martikainen PM, Vessella RL, Tammela TL, Visakorpi T (2008) TMPRSS2:ERG fusion identifies a subgroup of prostate cancers with a favorable prognosis. Clinical cancer research : an official journal of the American Association for Cancer Research 14(11):3395–3400. doi:10.1158/1078-0432.ccr-07-2051

  38. 38.

    Yaskiv O, Zhang X, Simmerman K, Daly T, He H, Falzarano S, Chen L, Magi-Galluzzi C, Zhou M (2011) The utility of ERG/P63 double immunohistochemical staining in the diagnosis of limited cancer in prostate needle biopsies. Am J Surg Pathol 35(7):1062–1068. doi:10.1097/PAS.0b013e318215cc03

  39. 39.

    Shah RB, Tadros Y, Brummell B, Zhou M (2013) The diagnostic use of ERG in resolving an “atypical glands suspicious for cancer” diagnosis in prostate biopsies beyond that provided by basal cell and alpha-methylacyl-CoA-racemase markers. Hum Pathol 44(5):786–794. doi:10.1016/j.humpath.2012.06.024

  40. 40.

    Lee SL, Yu D, Wang C, Saba R, Liu S, Trpkov K, Donnelly B, Bismar TA (2015) ERG expression in prostate needle biopsy: potential diagnostic and prognostic implications. Applied immunohistochemistry & molecular morphology : AIMM / official publication of the Society for Applied Immunohistochemistry 23(7):499–505. doi:10.1097/pai.0000000000000119

  41. 41.

    Gao X, Li LY, Zhou FJ, Xie KJ, Shao CK, Su ZL, Sun QP, Chen MK, Pang J, Zhou XF, Qiu JG, Wen XQ, Yang M, Bai XZ, Zhang H, Ling L, Chen Z (2012) ERG rearrangement for predicting subsequent cancer diagnosis in high-grade prostatic intraepithelial neoplasia and lymph node metastasis. Clinical cancer research : an official journal of the American Association for Cancer Research 18(15):4163–4172. doi:10.1158/1078-0432.ccr-11-2449

  42. 42.

    Han B, Suleman K, Wang L, Siddiqui J, Sercia L, Magi-Galluzzi C, Palanisamy N, Chinnaiyan AM, Zhou M, Shah RB (2010) ETS gene aberrations in atypical cribriform lesions of the prostate: implications for the distinction between intraductal carcinoma of the prostate and cribriform high-grade prostatic intraepithelial neoplasia. Am J Surg Pathol 34(4):478–485. doi:10.1097/PAS.0b013e3181d6827b

Download references

Author information

Correspondence to Najla Aldaoud.

Ethics declarations

This study was approved by the Institutional Review Board of Jordan University of Science and Technology.

Conflict of interest

The authors declare that they have no conflict of interest.


This research was funded by the grant from the Deanship of Research, Jordan University of Science and Technology, Irbid, Jordan.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aldaoud, N., Abdo, N., Al Bashir, S. et al. Prostate cancer in Jordanian-Arab population: ERG status and relationship with clinicopathologic characteristics. Virchows Arch 471, 753–759 (2017). https://doi.org/10.1007/s00428-017-2160-9

Download citation


  • Prostate cancer
  • Jordan
  • Immunohistochemistry