One day in Chicago, Dave Bigg is about to drink a few beers with his buddies and divvy up Cubs baseball tickets when his cell phone rings. It's the doctor, and he doesn't like what he sees.
Bigg's biopsy looks bad. The cells from his prostate are warped and buckled. It's cancer.
Bigg can't believe what he's hearing. He's 46 years old. He doesn't look sick. He doesn't feel sick. He feels great -- he's training for a triathlon.
“It was like a punch in the stomach,'' Bigg recalls.
Bigg phones his wife, Melissa. She's about to have lunch with friends near their home in Deerfield, Illinois. She sits in her car and screams. Cancer? How can my husband have cancer?
“You can't wrap your mind around it,'' she says. “You look at this healthy, energetic guy, and you can't believe it.''
This year, more than 230,000 men in the U.S. will get bad news like Bigg's, according to the American Cancer Society.
Bigg, who makes his living trading corn options on the Chicago Board of Trade (CBOT), says he's one of the fortunate ones. A blood test during a routine physical provided the first, vital clue that something was wrong. His blood showed elevated levels of prostate-specific antigen, a marker for cancer.
That first PSA test led to a second, which led to a biopsy, which uncovered a dangerous tumor. Bigg underwent a prostatectomy.
Dr. Patrick Walsh of Johns Hopkins University School of Medicine in Baltimore, who invented modern prostate surgery, says the PSA test saves lives. The U.S. death rate from prostate cancer fell 27 percent from 1991 to 2001 because more men are getting tested, says Walsh.
Bigg's surgeon, Dr. William Catalona of Northwestern University Feinberg School of Medicine in Chicago, has performed more than 4,500 prostatectomies and is a vociferous proponent of early screening. In 1991, he showed that PSA could be used to screen for prostate cancer.
Catalona and Walsh say men should get their first PSA test at 40. “It's such an easy thing to do,'' Catalona says. “Otherwise, you're sticking your head in the sand.''
Bigg says he thought he was too young and healthy to get prostate cancer. Until he got that call from his doctor, Bigg says he never dreamed he'd be among those afflicted, even after his PSA readings came back high.
During the exam, the doctor drew blood for a PSA test. PSA normally leaves the prostate through ducts leading to the urethra. Cancerous prostate cells leak above-average amounts of PSA into the bloodstream. PSA is measured in nanograms, or billionths of a gram, per milliliter. For a man of 45, a PSA reading of more than 2.5 ng/ml is cause for concern, Walsh says.
Bigg's PSA reading came back at 3.6. He says he wasn't alarmed. He'd been biking hard to train for a triathlon, which he'd heard could inflate PSA numbers. “I was ready to blow it off,'' he says.
Then, four months later, Dave's younger brother Steve got wind of his PSA results. Steve happens to be a urologist. He told Dave to get tested again.
This time, Bigg's results were even worse -- around 4 ng/ml. Bigg's doctor told him to get a biopsy, and he agreed. Working on the CBOT has taught him a few things. “I'm a believer in the trend,'' he says.
In a biopsy, a doctor harvests cells by inserting an ultrasound probe into the rectum, along with a gun that shoots a hollow needle through the rectal wall and into the prostate. The needle returns a core sample of tissue about a half inch (15 millimeters) long. Most doctors take a dozen cores.
Bigg's doctor sent the sample to a pathologist, who examined the cells under a microscope. Pathologists look for cells that are misshapen. The more deformed those cells are, the worse the cancer is. Pathologists assess the patterns and assign what's called a Gleason grade, from 1 to 5.
A Gleason grade of 1 indicates the malignant cells are close to normal. A score of 5 means the cells are almost unrecognizable as prostate cells -- a sign of severe cancer.
Most men have cells that fall into at least two categories, so pathologists add the grade for the most-prevalent type to the grade for the second-most-prevalent type for a combined Gleason score, or sum. Hence, a 2 is the best Gleason score (1 + 1), and 10 is the worst (5 + 5).
Because the first number in the Gleason score indicates the more prevalent cell type, you're better off if the first number is the lower of the two. A Gleason 4 + 3 is worse than a Gleason 3 + 4, for example. In the latter, most of the cells are Gleason 3, not 4.
As a rule, a Gleason sum of 6 or less means that the cancer is treatable. A sum of 8 or more suggests cancer cells have escaped the prostate.
Bigg's Gleason grades were: 4 + 3, for a combined score of 7.
When Bigg and his wife got home that day, they held each other.
Dave called his brother and asked his advice.
“I told my brother, `If you don't have surgery, you're crazy,''' Steve says. Steve recommended Dave see Catalona at Northwestern, who removed the prostate of New York Yankees Manager Joe Torre in 1999.
Steve Bigg had a connection, too. He'd trained under Catalona. “He's the man,'' he says.
Prostate surgery takes practice. Results vary from surgeon to surgeon, and it's not always easy to get in to see a top doctor. No U.S. government agency or organization tracks how many of the patients a doctor treats end up impotent and incontinent. Patients have to trust what their doctors tell them.
Catalona says about 85 percent of his prostate surgery patients in their 50s can get erections afterward. Walsh at Johns Hopkins says men who come to him in their 40s and 50s have a 90 percent chance. “It can take a little Viagra,'' says Walsh.
Bigg told Catalona that he wanted the cancer out, whatever the cost. He says he cared more about surviving than he did about sex. He and his wife have two grown children, ages 22 and 18, and didn't want any more, so Bigg didn't bank his sperm. Men still produce sperm after a prostatectomy, but the sperm no longer reach the urethra, the canal that runs through the penis.
Bigg had to wait for the biopsy holes in his prostate to heal before Catalona could operate. ``That's the longest two months of anyone's life,'' Melissa Bigg says.
Bigg hit the pool, hard. Just before surgery, he placed second in his age group in the 100-yard butterfly in the Illinois Masters Swimming Association championships. He swam faster than he had in high school. “What's scary is that you can feel so good and have this,'' Bigg says.
Halfway through Bigg's operation, Catalona called Melissa Bigg and told her things looked good. Bigg's cancer hadn't spread. For the first time in months, she felt relieved.
Bigg was discharged from the hospital. He wore a catheter for a week while his urethra, which has to be cut, healed. He took a month off from work to recuperate. For the first three months after his surgery, Bigg leaked urine when he screamed on the trading floor. Since then, he's had no problems, he says.
Bigg and his wife say the surgery hasn't diminished their sex life. ``Erections aren't what they were like when I was 16, but they weren't anyway,'' Bigg says.
“I have no complaints,'' Melissa Bigg says.
Bigg is back in the pool. He competed in the Masters World Championships at Stanford University in August.
Around her neck, Melissa Bigg wears a ruby encircled by diamonds. Ruby is Dave Bigg's birthstone; diamond is hers. The necklace was a 23rd anniversary present from Bigg.
He says the charm symbolizes how he felt during his battle with cancer: surrounded by her love.