TMPRSS2-ERG fusion detected on tumor RNA / FISH / IHC for ERG in localized or metastatic...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-PROSTATE-TMPRSS2-ERG-PROGNOSTIC`
Type	Red flag
Status	reviewed 2026-04-29 \| pending_clinical_signoff
Diseases	`DIS-PROSTATE`
Sources	`SRC-ESMO-PROSTATE-2024` `SRC-NCCN-PROSTATE-2025`

Red Flag Origin

Definition	TMPRSS2-ERG fusion detected on tumor RNA / FISH / IHC for ERG in localized or metastatic prostate cancer — INFORMATIONAL prognostic signal. Most common recurrent gene fusion in prostate cancer (~40-50% of localized PCa, ~15-30% of mCRPC). Conflicting prognostic literature: some series report worse PSA-relapse-free survival post-prostatectomy, others report no independent prognostic value after adjusting for Gleason / PSA / stage. NO predictive role established for ARSI, PARPi, taxane, or radioligand selection — does NOT modify treatment algorithm. Surfaces in MDT brief as: (1) molecular subtyping context, (2) potential clinical-trial enrollment criterion (ERG-positive cohorts in some experimental studies), (3) helpful for confirming prostate origin in metastatic-of-unknown-primary workup (TMPRSS2-ERG is highly prostate-specific).
Clinical direction	investigate
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "tmprss2_erg_fusion",
      "value": "positive"
    },
    {
      "finding": "tmprss2_erg",
      "value": "positive"
    },
    {
      "finding": "erg_rearrangement",
      "value": "positive"
    },
    {
      "finding": "erg_ihc",
      "value": "positive"
    }
  ],
  "type": "biomarker"
}

Notes

References BIO-TMPRSS2-ERG-FUSION. Detection: FISH break-apart probe is gold standard; ERG IHC (anti-ERG monoclonal) is a high-sensitivity surrogate (~95-99% concordance with FISH for ERG-rearranged tumors). RNA-seq detects the specific fusion partner. Severity = minor and priority = 90 reflect informational-only status (lower clinical weight than AR-amp / AR-V7 which inform sequencing decisions even if not algorithm-shifting). Distinguishes molecular subtype but does not shift the treatment plan in 2026 evidence base. Useful as a histogenesis confirmation tool in metastasis-of-unknown-primary workup with adenocarcinoma morphology.

Used By

No reverse references found in the YAML corpus.