
Prognostic biomarkers for prostate cancer are needed to improve the prediction of disease course and guide treatment decisions. However, biomarker development is complicated by the common multifocality and heterogeneity of the disease. The present study aimed to determine the prognostic value of the candidate biomarkers transcriptional regulator ERG and related ETS family genes while considering tumour heterogeneity. Intra‐ and interfocal heterogeneity was identified in patients with 29 and 33% (ERG protein) and 39 and 27% (ETS RNA). ERG protein and ETS RNA were identified exclusively in a non‐index tumour in 31 and 32% of patients, respectively. ERG protein demonstrated independent prognostic value in predicting biochemical (p=0.04) and clinical recurrence (p=0.004) and appeared to have the greatest prognostic value for patients with Grade Groups 4–5. In conclusion, when heterogeneity is considered, ERG protein is a robust prognostic biomarker for prostate cancer.
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