The presence of ETS gene re-arrangements in prostate cancer may indicate worse prognosis with the sub-class 2+Edel, which has duplication of the re-arrangement, indicating particularly poor survival. However as this case demonstrates, significant heterogeneity can exist with ERG and ETV1 rearrangements occurring in both PIN and cancer in the same prostatectomy specimen and with adjacent cancer areas containing a single copy, duplication and even triplication of the rearranged locus. As the majority of ETS gene fusions are hormone regulated, they could explain the pathogenesis underlying exquisitely hormone-sensitive prostate cancer exemplified by the case presented here of a patient diagnosed in 1991 who remains asymptomatic and chemotherapy-naïve after having long-lasting tumour responses to multiple lines of systemic hormonal treatments.
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