BOSTON -- When it comes to a prostate cancer test, the score's change over time may be more important than one individual score.

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PSA Test May Reveal More

Typically, a reading of 4.0 on the prostate-specific antigen, or PSA, test is suspect and most doctors would call for a biopsy of the prostate.

But researchers at Brigham and Women's Hospital said that it may not be that number itself but how it changes over time that matters.

In a study published in Wednesday's issue of the New England Journal of Medicine, the researchers studied records of about 2,000 men who had their prostates removed because of cancer. In looking at their PSA levels before surgery, they found when the number jumped more than two points in one year, patients were more likely to die from the disease, even after their prostate was removed.

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"These guys that slowly climb rather than those guys that are stable and then boom, have a step up. I think that's where we're going to get the information telling us actually who has significant versus insignificant cancers," said Dr. Anthony D'Amico, of Brigham and Women's Hospital.

The researchers said the results make it "very clear" that men whose levels jump can't afford what is called "watchful waiting" -- holding off on having treatment or surgery.

The American Cancer Society ranks prostate cancer as the second-leading cancer killer among men.

Microwaving Prostates?

If you're a middle-aged man or older, you might recognize Ken Wilkinson's symptoms of an enlarged prostate.

"You'd wake up with the urge to go, go to the bathroom," Wilkinson said. "Not very much would happen, and then you'd go back to bed again, and then an hour or so later, you'd be up again."

The cause is benign prostatic hyperplasia, or BPH.

"It's not cancer, and what it does is cause bothersome symptoms, symptoms of urgency, frequency, having to know where the bathroom is when you go out of the house," said Dr. Ronald Melman, of Montefiore Medical Center in New York.

This kind of benign enlargement is usually treated with a variety of medications. When they fail, or the side effects are too bothersome, another option is surgery and there are several minimally invasive techniques using lasers or microwaves.

"The downside of the surgical procedures are that there's anesthesia, there's bleeding, there's hospital time," Melman said.

But now there is a new approach combining the microwaves used in other prostate techniques with an idea borrowed from heart procedures -- a balloon to open up the constricted urethra or urine tube passing through the prostate.

"I've been using this device for almost five years now, and I haven't really had any major complications," Melman said.

A tube is passed through the penis into the bladder so a balloon can be inflated in the prostate, just as an angioplasty works in heart arteries. Then microwaves heat the prostate from the inside. The combination creates a kind of stent inside the prostate.

Melman said it actually damages the nerves within the prostate, which helps reduce the symptoms.

"It is these nerves that are in the prostate that cause the urgency and frequency in the bladder, and that's what really bothers men," he said. "I mean, rarely, rarely do I get up during the night and um, you know, I can drive for four hours without worrying about it."

So far, the long-term follow-up is up to five years, and the symptom improvement seems to be holding.

The Prolieve Thermodilatation system is not for all men with BPH. It is best for those with moderate to severe symptoms and with moderate to fairly enlarged prostates.