Modern Pathology advance online publication 8 January 2016; doi: 10.1038/modpathol.2015.148
Clonal evaluation of prostate cancer foci in biopsies with discontinuous tumor involvement by dual ERG/SPINK1 immunohistochemistry
Jacqueline Fontugne, Kristina Davis, Nallasivam Palanisamy, Aaron Udager, Rohit Mehra, Andrew S McDaniel, Javed Siddiqui, Mark A Rubin, Juan Miguel Mosquera and Scott A Tomlins
Abstract
The
presence of two or more prostate cancer foci separated by intervening
benign tissue in a single core is a well-recognized finding on prostate
biopsy. Cancer involvement can be measured by including intervening
benign tissue or only including the actual cancer involved area.
Importantly, this parameter is a common enrollment criterion for active
surveillance protocols. We hypothesized that spatially distinct prostate
cancer foci in biopsies may arise from separate clones, impacting
cancer involvement assessment. Hence, we used dual ERG/SPINK1 immunohistochemistry to determine the frequency of separate clones—when separate tumor foci showed discordant ERG and/or
SPINK1 status—in discontinuously involved prostate biopsy cores from
two academic institutions. In our cohort of 97 prostate biopsy cores
with spatially discrete tumor foci (from 80 patients), discontinuous
cancer involvement including intervening tissue ranged from 20 to 100% and Gleason scores ranged from 6 to 9. Twenty-four (25%) of 97 discontinuously involved cores harbored clonally distinct cancer foci by discordant ERG and/or SPINK1 expression status: 58% (14/24) had one ERG+ focus, and one ERG−/SPINK1− focus; 29% (7/24) had one SPINK1+ focus and one ERG−/SPINK1− focus; and 13% (3/24) had one ERG+ focus and one SPINK1+ focus. ERG and SPINK1 overexpression were mutually exclusive in all tumor foci. In summary, our results show that ~25% of discontinuously involved prostate biopsy cores showed tumor foci with discordant ERG/SPINK1
status, consistent with multiclonal disease. The relatively frequent
presence of multiclonality in discontinuously involved prostate biopsy
cores warrants studies on the potential clinical impact of clonality
assessment, particularly in cases where tumor volume in a discontinuous
core may impact active surveillance eligibility.
