TMPRSS2-ERG Fusion Transcripts in Matched Urine and Needle Rinse Material after Biopsy for the Detection of Prostate Cancer: Really a Step Forward?

Prostate cancer (PCa)3 is the most common malignancy in America, Western Europe, and Australia, and there are large discrepancies in incidence rates. In a few countries in South America and Africa and in Sweden, PCa is the leading cause of cancer deaths (1). Prostate-specific antigen (PSA) is the best available tumor marker. It has an irreplaceable role for PCa follow-up and prognosis but has severe limitations for diagnosing PCa (2). The low diagnostic specificity and positive predictive value of only approximately 25% for screening (3) encourages opponents of PSA to be overly critical and to neglect some of its contributions (e.g., dramatic reduction of metastatic disease and a mortality rate reduced by approximately 20% (4). Other problems, such as a reduced diagnostic sensitivity and the overdetection with a 4-μg/L PSA cutoff and subsequent overtreatment (5), support the need for new biomarkers that overcome these obstacles. Although the vast majority of patients with PCa will not die from the disease, the goal is to detect aggressive and life-threatening PCa. Therefore, scientists are searching for more PCa-specific markers that can preferentially detect aggressive cancer. As recent examples, a subform of free PSA, [−2]proPSA (6), and the urinary PCa antigen 3 (PCA3) have already shown some promising results (7).The discovery of fusion transcripts for the TMPRSS2 4 (transmembrane protease, serine 2) and ERG [v-ets erythroblastosis virus E26 oncogene homolog (avian)] genes (i.e., TMPRSS2-ERG ) in PCa tissue was one of …