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Context and objective The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localized prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies. Acquisition of evidence A systematic literature review was conducted of the treatment of localized prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D’Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer. Synthesis of the evidence After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomized. The patients’ mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6–100% for cryotherapy and 96–100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86–100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9–100%) and total therapy (39%). HIFU showed potency rates of 89%, 52–80% and 33–78% for focal therapy, hemiablation and total therapy, respectively. Conclusions Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centers with high volumes of patients.

Resumen Contexto y objetivo El diagnostico cada vez mas precoz del cancer de prostata obliga a buscar alternativas terapeuticas con buenos resultados oncologicos, que a su vez faciliten una buena calidad de vida a largo plazo. La presente revision analiza los resultados de 2 terapias minimamente invasivas en el tratamiento del cancer localizado de prostata en cuanto a resultados oncologicos y funcionales, asi como las complicaciones derivadas de los mismos. Adquisicion de la evidencia Revision sistematica de la literatura referida al tratamiento del cancer localizado de prostata con 2 tecnicas ablativas como terapia primaria: la criocirugia o crioterapia y el high intensity focused ultrasound (HIFU). Se incluyen pacientes con procedimientos que incluian la totalidad de la glandula, con hemiablacion o con terapia focal e indicados en cancer de prostata de bajo riesgo o riesgo intermedio segun criterios D’Amico. Se excluyen pacientes con cancer de prostata de alto riesgo, o aquellos que hayan recibido cualquier tratamiento previo para el cancer de prostata. Sintesis de la evidencia Tras la busqueda y exclusion de estudios que no cumplian los criterios del protocolo, se revisan un total de 14 estudios, con un total de 350 pacientes tratados mediante crioterapia, y un total de 1.107 pacientes tratados con HIFU. En todos los casos se trataron de estudios prospectivos o retrospectivos, no aleatorizados. La edad media de los pacientes fue de menos de 75 anos. En global la tasa de recidiva anatomopatologica en los pacientes tratados con crioterapia oscila entre el 13,2% y el 26%, mientras que en el HIFU oscilan entre el 7,3% y el 67,9%. La continencia global mostrada fue de un 97,6-100% en el caso de la crioterapia, y un 96-100% en el HIFU a los 12 meses. Respecto a las tasas de potencia sexual la crioterapia muestra una potencia completa del 86-100% a los 12 meses en pacientes tratados con crioterapia focal, y algo menores en la hemiablacion (76,9-100%) y en la terapia total (39%). El HIFU reporta tasas de potencia del 89% 52-80% y 33-78% en terapia focal, hemiablacion y terapia total respectivamente. Conclusiones Ambas tecnicas presentan unos resultados funcionales equiparables, si bien los resultados oncologicos algo mas pobres en el HIFU son reflejo de una curva de aprendizaje mas complicada, que puede abocar su uso a centros con alto volumen de pacientes.

The increasingly early diagnosis of prostate cancer requires a search for therapeutic alternatives with good oncological results that in turn facilitate a good long-term quality of life. This review analyses 2 minimally invasive therapies for treating localised prostate cancer in terms of oncological and functional results, as well as the complications resulting from the therapies.A systematic literature review was conducted of the treatment of localised prostate cancer with 2 ablative techniques as the primary therapy: cryosurgery or cryotherapy and high intensity focused ultrasound (HIFU). We included patients who underwent procedures that included the entire gland, with hemiablation or focal therapy, which were indicated for low to intermediate-risk prostate cancer according to the D'Amico criteria. We excluded patients with high-risk prostate cancer and those who underwent any prior treatment for prostate cancer.After conducting the literature search and excluding the studies that did not meet the protocol criteria, we reviewed a total of 14 studies, with a total of 350 patients treated using cryotherapy and 1107 treated with HIFU. All studies were either prospective or retrospective and were not randomised. The patients' mean age was younger than 75 years. Overall, the rate of disease recurrence in the patients treated with cryotherapy varied between 13.2% and 26%, while the rate for those treated with HIFU varied between 7.3% and 67.9%. The overall demonstrated continence at 12 months was 97.6-100% for cryotherapy and 96-100% for HIFU. In terms of sexual potency rates, cryotherapy showed complete potency at 12 months for 86-100% of the patients treated with focal cryotherapy and slightly lower rates for hemiablation (76.9-100%) and total therapy (39%). HIFU showed potency rates of 89%, 52-80% and 33-78% for focal therapy, hemiablation and total therapy, respectively.Both techniques have comparable functional results, although the somewhat poorer oncological results for HIFU reflect a steeper learning curve, which could lead to its use in centres with high volumes of patients.

Around 10 % of renal cell carcinomas (RCC) are cystic, while some benign cysts have complex appearance in conventional diagnostic tests such as computed tomography (CT) or magnetic resonance imaging (MRI). These renal complex cystic masses (RCCMs) are a challenging entity in urological practice and sometimes have a difficult management, requiring surgical removal. Contrast-enhanced ultrasound (CEUS) is a very sensitive test detecting microvascularization in real time, and it has been used in the diagnostic workup of these kinds of lesions. The aim of our study was to assess the diagnostic power of CEUS in the evaluation of RCCM. This is a prospective observational study between April 2011 and July 2014. A total of 66 patients with 67 RCCMs were enrolled (Bosniak 2–4). Twenty-four patients underwent surgical removal of the RCCM. All participants underwent CEUS (experimental) and CT (control). All CEUS procedures were performed by a single high-experienced observer (urologist). Benign lesions were defined as those Bosniak 2–2F, and malignant were Bosniak 3–4. Statistical analysis was made measuring consistency (kappa index and Landis-Koch scale) and validity (sensitivity, specificity, positive and negative predictive values) of the study. Median size of RCCM measured by CEUS and CT was 3.8 cm (interquartile range (AIQ) 3.2–4.6) and 3.9 cm (AIQ 3.2–4.5), respectively. Kappa index shows good agreement between both tests (0.71; 95 % CI 0.57–0.85), both overall and stratified by categories according to Bosniak classification. CEUS has a sensitivity 100 %, specificity 81.4 %, positive predictive value 70.4 %, and negative predictive value 100 %. A total of eight RCCMs were discordant, and seven of eight classified as malignant by CEUS and not by CT. Of those seven lesions classified as malignant by CEUS, six (six of seven, 85.7 %) were malignant in the pathological exam. CEUS is a very useful tool for assessing RCCM, with good results in terms of consistency and validity. It has a good diagnostic power, with a sensitivity of 100 % and a negative predictive value of 100 %. Its main limitations are the experience required, a special software, and being observer-dependent.

El tumor de células renales supone el 1% de los tumores del adulto, mientras que el carcinoma transicional tiene una incidencia del 7%. La aparición simultánea de un carcinoma de células renales, y un tumor transicional de pelvis en el mismo riñón, suponen un hecho excepcional no existiendo más de 30 casos publicados en el mundo, presentando una incidencia aproximada del 0,14% de la patología tumoral renal. Presentamos un nuevo caso de esta inusual asociación que supone el 4 caso referenciado en la literatura en español.

Se presenta un nuevo caso de carcinoma renal sarcomatoide, en un varón de 67 años con recidiva locorregional a los 4 meses de la cirugía, con dos episodios de hemorragia retroperironeal tras la segunda intervención. El objetivo de este trabajo es aportar un nuevo caso y hacer una revisión de la bibliografía.

Strict imaging follow-up is mandatory after cryoablation of small renal masses (SRMs). Although it uses ionizing radiation and nephrotoxic iodinated contrast, computed tomography (CT) is still the gold standard test. Contrast-enhanced ultrasound (CEUS) is a novel technique that informs in real time about renal perfusion avoiding radiation and nephrotoxicity. The objective of this study is to compare outcomes between CEUS and CT in the follow-up of SRMs treated with cryoablation, as well as to assess degree of agreement between them. This is a prospective observational study (May 2012 to December 2013) comparing CEUS and CT in 16 patients with SRMs cryoablated. The on-going protocol of the study includes a CT and CEUS 3 months after treatment and then every 6 months during 5 years. Local relapse was defined as the presence of contrast enhancement in the mass. All the CEUS were performed by a single experienced observer (E.S.). Degree of agreement was measured with kappa index. CEUS detected contrast enhancement in three patients (3/16, 18.8 %) and CT in two patients (2/16, 12.5 %). Degree of agreement between CEUS and CT, according to Landis-Koch classification, was 0.76 (CI 0.33–1.19; p = 0.0165), which is excellent and higher than expected by random. Sensitivity of the test is 93.75 % (15/16). Median time of follow-up after cryoablation is 22 months (15.5–36.5). CEUS has an excellent agreement with CT and a high sensitivity in the follow-up of SRMs treated with cryosurgery, demonstrating its usefulness. Due to these encouraging results, it could become a reference test in the near future for monitoring SRMs after ablative treatment.

Purpose.Published data about cryotherapy for prostate cancer (PC) treatment are based on case series with a lack of clinical trials and the inexistence of a validated definition of biochemical failure. A prospective study with standardized followup protocol was conducted in our institution.Material and Methods.Prospective study of a series of cases including 108 patients diagnosed with localized PC at clinical stage T1c-T2c treated by primary cryoablation and median followup of 61 months. Criteria of biochemical recurrence were unified according to the American Society for Therapeutic Radiology and Oncology (ASTRO). End points were biochemical progression-free survival (BPFS), cancer-specific survival, and overall survival. Rate of complications was reported.Results.The BPFS for low-, medium-, and high-risk patients was 96.4%, 91.2%, and 62.2%, respectively. Cancer-specific survival was 98.1%. Overall survival reached 94.4%. Complications included incontinence in 5.6%, urinary tract obstruction in 1.9%, urethral sloughing in 5.6%, haematuria in 1.9%, perineal pain in 11.1%, and prostatorectal fistula in 0.9%. Erectile disfunction was found in 98.1%.Conclusions.Cryotherapy is an effective and minimally invasive treatment for primary PC in well-selected cases, with low surgical risk and good results in terms of BPFS, cancer-specific survival, and overall survival.

Resumen Objetivo Se revisa el resultado de las biopsias prostaticas ecodirigidas en sextantes repetidas para establecer los criterios de re-biopsia, haciendo especial enfasis en los cambios histologicos de Atipia Glandular Focal (AGF). Material Y Metodo Se seleccionan 192 casos, de una serie global de 1.957 pacientes mayores de 50 anos, re-biopsiados por PSA elevado y/o TR anormal, o por los hallazgos histologicos de las biopsias iniciales (PIN-alto grado y/o AGF). Los resultados se relacionan con los niveles de PSA serico y con los caracteres del TR. Resultados Se obtuvo una positividad global para cancer del 38,83% y de la re-biopsia del 27,08%. Cuando la 1 a biopsia habia sido negativa, la positividad de las re-biopsias fue del 19,37%, si habia sido negativa para cancer pero con cambios de PIN-alto grado y/o AGF, la positividad fue del 65,62%, siendo mayor en los casos de AGF que en los de PIN (68,00% vs. 57,14%). El TR anormal elevo la tasa de positividad de 17,82% a 35,71%. Conclusiones La positividad estaba primordialmente relacionada con la existencia de TR anormal y/o con un PSA ??10 ng/ml. Los cambios de AGF (3,47% global) han tenido un valor predictivo de cancer del 65,62%. La tasa de tumores detectados en la 2 a biopsia, y en la 3 a o posteriores, fue similar (19,28% vs. 21,74%). Se recomienda re-biopsiar a todos los pacientes con cambios de AGF.

Resumen Objetivo Presentar un caso de recidiva de carcinoma epidermoide de pene a los 21 anos de la cirugia. Metodo Se trata de un paciente de 85 anos con antecedentes de penectomia parcial por carcinoma epidermoide, que presenta lesion excrecente a nivel de glande de 1 mes de evolucion. Se biopsia siendo el resultado carcinoma epidermoide por lo que se realiza penectomia total con uretrostomia cutanea. Resultado El estudio histopatologico de la pieza confirmo un carcinoma epidermoide bien diferenciado.

La biopsia transrectal ecodirigida es actualmente el metodo mas eficaz para el diagnostico del carcinoma prostatico. A pesar de que en la mayoria de los protocolos se emplea profilaxis antibiotica, las complicaciones infecciosas se encuentran entre las de mayor gravedad. Presentamos un caso de meningitis por E. coli multirresistente despues de la realizacion de una biopsia transrectal de prostata a pesar de la profilaxis con quinolonas.

UNLABELLED 194 metastatic breast cancer patients with no prior chemotherapy for advanced disease were randomized to one of two alternating schedules, fulfilling the requisites of Goldie and Coldman's hypothesis to evaluate if the earlier alternation of two non-cross resistant regimens is superior in terms of response (R), duration of R (DR), and survival (SV). TREATMENT arm A: Adriamycin (A) 60 mg/m2 IV day (d) 1 and vincristine (V) 1.4 mg/m2 IV d 1 and 8 monthly alternated with cyclophosphamide (C) 100 mg/m2 p.o. d 1-14; methotrexate (M) 30 mg/m2 IV d 1 and 8; 5-fluorouracil (F) 600 mg/m2 IV d 1 and 8 and prednisone (Pr) 40 mg/m2 p.o. d 1-14. Arm B (hybrid): A 60 mg/m2 IV d 1; V 1.4 mg/m2 IV d 1; C 100 mg/m2 p.o. d 8-14; M 30 mg/m2 IV d 8; F 600 mg/m2 IV d 8 and Pr 40 mg/m2 p.o. d 8-14. RESULTS 87 and 89 patients are evaluable for R. Arm A: R= 59% (51/87); median DR= 13 months (m); median SV= 25 m. Arm B: R= 69% (61/89); median DR= 15 m.; median SV= 29 m. Myelosuppression was slightly more marked in arm B. Three patients had toxic-related deaths (arm A: 1; arm B: 2). CONCLUSIONS a trend favoring an earlier alternation and higher dose intensity (DI) was found regarding to R, DR and SV. However, differences were not statistically significant.

The objective was to define the toxicity and activity of weekly docetaxel administered with a short course of estramustine and enoxaparine in patients with hormone-resistant prostate cancer (HRPC).Twenty-four patients were treated with the next regimen: weekly docetaxel 36 mg/m(2) iv for three consecutive weeks every 28 days, and estramustine 280 mg three times a day for three consecutive days beginning the day before docetaxel (days 1-3, 8-10 and 15-17). In order to prevent thromboembolic events, 40 mg of subcutaneous enoxaparine was administered daily sc on the same days as estramustine. Primary endpoints were: toxicity, especially the presence of thromboembolic events, PSA response rate and response in measurable disease. Secondary endpoints were: time to PSA progression and overall survival.Nineteen of 24 patients (79.1%, 95% CI 71-87%) had a PSA response = or50%. Four of the eleven patients with measurable disease had a partial response. The median time to PSA progression was 7 months (CI 95%: 6.5-9) and the median survival was 19 months (IC 95%: 11-24). Toxicity was manageable with no treatment- related mortality. Only two patients had grade 4 neutropenia. Two patients had thrombotic events, one deep venous thrombosis and one stroke. The main grade 3 non-haematologic toxicity was diarrhoea and asthenia, both in 25% of patients.Weekly docetaxel with a short course of estramustine and enoxaparine is active and tolerable in HRPC patients. The observed incidence of thrombosis was lower than previously reported but the association of enoxaparine was not enough to completely prevent the thromboembolic events.

To review the incidence of PIN and Atypical Small Acinar Proliferation (ASAP) on first biopsy, the risk to find cancer on following biopsies and what is the importance given to this findings, analizing how frequently and how long after the initial finding this patients are rebiopsied.We selected 6000 patients who underwent TRUS biopsy between 1994 and 2002. Patients with prior cancer diagnosis were not included. 861 of them underwent more than one biopsy, adding up to a total of 7127 biopsies. A descriptive study has been done including percentages and percentiles for qualitative variables, mean and median for continuous variables.Incidence of cancer on the first biopsy was 39,1%. PIN and ASAP are stable or slightly increase from 2 and 2,1% respectively on the first biopsy to more than 6% on the fourth and fifth ones. Mean time between biopsies when ASAP or PIN are the initial findings is 180 +/- 221,6 and 264 +/- 213,8 days respectively. Just 42 and 40% of patients with prior PIN or ASAP diagnose are rebiopsied. On subsequent biopsies 45 and 40% of cancers were respectively found.Presence of PIN or ASAP implies a higher cancer risk on subsequent biopsies; in spite of that, less than half of them are biopsied again. Performing two more biopsies or an amplified biopsy can find most of the tumors associated.

Resumen Objetivo Revisar la incidencia de Neoplasia Intraepitelial Prostatica (PIN) y Atipia Glandular Focal (AGF) en primera biopsia, el riesgo de estos pacientes de padecer cancer en biopsias sucesivas y que importancia se concede a estos hallazgos analizando con que frecuencia son rebiopsiados estos pacientes y cuanto tiempo despues del hallazgo inicial. Metodo Estudio retrospectivo sobre 6.000 pacientes biopsiados entre 1994 y 2002. No se han incluido pacientes con diagnostico previo de cancer. De los 6.000 pacientes 861 se han rebiopsiado en alguna ocasion sumando en conjunto 7.127 biopsias. Se ha realizado un estudio descriptivo que incluye los porcentajes y percentiles para variables cualitativas y medidas de tendencia central para las variables cuantitativas continuas. Resultados La incidencia de cancer en la primera biopsia fue del 39,1%. Las cifras de PIN o AGF se mantienen estables o aumentan progresivamente desde un 2 y 2,1% respectivamente en la primera biopsia hasta mas del 6% en la cuarta y quinta biopsia. La media de tiempo entre biopsias en el caso de encontrar AGF o PIN en el diagnostico inicial es de 180± 221,6 y 264±213,8 dias respectivamente. Solo el 42 y el 40% de pacientes con diagnostico inicial de PIN o AGF se rebiopsian, encontrando finalmente un 45 y un 40% de tumores en las posteriores biopsias respectivamente. Conclusion La presencia de PIN o AGF implica un mayor riesgo de cancer en biopsias posteriores; a pesar de ello menos de la mitad vuelven a biopsiarse. La realizacion de dos biopsias posteriores o una biopsia ampliada localiza la mayoria de los tumores asociados.

The growing interest on increasing the number of biopsy samples during ultrasound guided prostatic biopsies moved us to evaluate the tolerability and complications of the extensive biopsy with/without blockage of neurovascular bundles.A group of 222 patients underwent prostatic biopsy with the aim to obtain 10 cores on each. After evaluation of the first 50 cases performed without anesthesia, decision was taken to proceed with neurovascular blockage with 2% lidocaine, comparatively evaluating both groups for results on tolerability, complications and global adverse events.The aimed number of cores could not be completed in 16% of the patients without anesthesia in comparison with 2.33% with anesthesia (p0.002); the biopsy was qualified as painful or very painful by 10.9% and 1.9% respectively (p0.0002). The results of the visual analogical scale for pain were 2.46 +/- 1.67 and 4.5 +/- 2.11 for the anesthesia/without anesthesia groups respectively, with mild-moderate vagal reactions in 28% of these latter in comparison with 7.7% in patients receiving lidocaine. Rectal bleeding was the most worrying complication, being moderate-severe in 4.7% of the patients, with 2% hospital admission.The increase in the number of ultrasound guided prostatic biopsy samples may be associated with a higher frequency of complications, mainly bleeding, and requires the application of local anesthesia due to worse tolerance. Neurovascular bundle blockage with lidocaine is very effective to diminish biopsy associated pain.

The renal cell tumour supposes 1% of the adult's tumors, while the transitional carcinoma has an incidence of 7%. The simultaneous appearance of a carcinoma of renal cells, and a transitional tumour of pelvis in the same kidney, they suppose an exceptional fact not existing but of 30 cases published in the world, presenting an approximate incidence of 0.14% of the pathology renal tumoral. We present a new case of this unusual association that supposes the 4 case indexed in the literature in Spanish.

The incidence of retroperitoneal primitive tumour varies from the 0.3 to 3%. The sarcomas suppose the group but it frequents of retroperitoneal tumour, being the Schwannoma an unusual tumour with an incidence from 1% to 50% of the retroperitoneal primary tumours. The schwannoma also denominated neurinoma or neurolenoma, it is a derived tumour of the cells of Schwann of the outlying nerves. It is characterized by their clinical and radiological inespecify, being the diagnose pathological, with intense positive inmunohistoquimics to the protein S-100. The election treatment is the surgical remove, with wide margins; not being described cases of malignización neither of metastasis at distance, but if the recurrence existence at probably secondary local level to incomplete resection.

Primary testicular lymphoma is an uncommon testicular tumour that accounts for no more than 9% of all testicular tumours in those series with higher incidence; testicular lymphoma as haematopoietic tumours are also rare accounting for just 1% of all lymphomas; but due to their highly malignant histopathology they may become highly aggressive tumours. Patient age at presentation is over 60 years old which makes it the most frequent tumour for this age group. There is no standard protocol to treat this malignancy due to lack of extensive series. We contribute one case and make a literature review discussing the current therapeutic trends for this disease.

We report a recidive of penis carcinoma after 21 years of surgery.This is the case of a male of 85 years old, with partial penectomy; by epidermoid carcinoma. In physics exploration, that it displays excrecente lesion at level of gland of 1 month of evolution. Biopsy being the result of epidermoid carcinoma reason why is made. Total penectomy, a with cutaneus uretrostomy.The histopathological study of the piece, confirm a epidermoid carcinoma well differentiated.

We report a new case of sarcomatoid renal cell carcinoma, in a male of 67 years old, with locoregional recidive four months after first surgery, with two episodes of retroperitoneal hemorrhage after second surgery. The objective of this work is to contribute a new case and of doing one revision.

To report the case of a solitary renal metastasis secondary to hepatocellular carcinoma.We report the case of a 51 year old patient who on abdominal ultrasonography was revealed a left renal tumour and a hepatic mass incidentally. A TAC showed the left renal tumor measuring 17 cm in size, possible involvement of left renal vein and a tumour mass in the right lobe of the liver. A TAC guided fine needle punction aspiration biopsy demonstrated a malignant hepatic lesion compatible with hepatocarcinoma, and malignant renal cells compatible with renal or adrenal carcinoma. Left radical nephrectomy and right hepatectomy was performed.Histopathologic study confirmed the diagnosis of moderately differentiated trabecular hepatocarcinoma with lymph node and left renal metastasis.

Transrectal prostate biopsy is the most accurate method for prostate cancer diagnosis. Although an antimicrobial prophylaxis is employed in most cases, infectious complications are among the most severe. We present a case of E. coli multirresistant meningitis after transrectal prostate biopsy despite quinolone prophylaxis.

Resumen “Metastasis Renal De Hepatocarcinoma” Objetivo Presentar el caso de una metastasis renal solitaria secundaria a hepatocarcinoma. Metodo Describimos el caso de un paciente de 51 anos que en ecografia abdominal se descubre incidentalmente una masa renal izquierda y una masa hepatica. En el TAC se objetivo la masa renal izquierda de 17 cm de diametro con posible afectacion de vena renal izquierda y una masa hepatica en lobulo derecho. La PAAF guiada por TAC de ambas masas demostro en higado celularidad maligna compatible con hepatocarcinoma, y en rinon celularidad maligna compatible con carcinoma renal o suprarrenal. Se indico tratamiento quirurgico con nefrectomia radical izquierda mas hepatectomia derecha. Resultado El analisis histopatologico de la pieza mostro hepatocarcinoma trabecular moderadamente diferenciado con metastasis ganglionar y renal izquierda.

We reviewed the result of transrectal ultrasound (TRUS)-guided needle biopsies to find the re-biopsy criteria, emphasizing on the Focal Glandular Atypia (FGA) histological changes.192 cases were selected, from a total of 1957 patients older than 50, re-biopsied because of high PSA levels and/or abnormal DRE, or because of the histological findings on initial biopsies (high grade PIN and/or FGA). The results are related to the serum PSA levels and DRE characteristics.A 38.83% global positivity for cancer was obtained and 27.08% for re-biopsy. When the first biopsy was negative, the positivity of the re-biopsies was 19.37%; if it was negative for cancer but had high grade PIN and/or FGA changes, the positivity was 65.62%, being higher in FGA changes than in the PIN cases (68.00% vs. 57.14%). The abnormal DRE raised the positivity rate from 17.82% to, 35.75%.The positivity was especially related to abnormal DRE and/or PSAor = 10 ng/ml. The tumor rate detected at second and third or successive biopsies was similar (19.28% vs 21.74%). The FGA changes (3.47% globally) had a cancer predictive value of 65.62%. We recommend re-biopsy in all patients with FGA changes.