Playing the Odds

No Deaths

Of those who have signed up, 55 percent are still monitoring their tumors. A third of the men have exhibited changes that prompted Carter to treat them. About 7 percent became so uncomfortable knowing they had cancer in their bodies that they chose treatment even though their tumors appeared stable. No one in Carter's program has died of prostate cancer.

Klotz at University of Toronto says he plans to recruit 2,100 patients to study active surveillance.

Looking back, Lewis suspects he had an infection in his prostate. His biopsy just happened to hit the trace of cancer that so many men carry around later in life, he says. ``Our bodies have cancers coming and going all the time,'' Lewis says.

Milken, the onetime junk bond king, has made fighting prostate cancer his life's work. In 1993, when Milken was 46, he went for an overdue physical. He had just finished a 22-month prison term for securities fraud. He asked his doctor for a PSA test. Prostate cancer had just killed Warner's Ross, a friend, and he wanted a test himself. The doctor told Milken he was too young to worry.

Grim Results

``Humor me,'' Milken said. He has lost 10 close relatives to cancer, including his father (melanoma) and his mother-in-law (breast cancer).

The results were terrible. Milken's PSA was 24 ng/ml, six times the level that usually prompts concern. Milken had a biopsy, and his Gleason score came back at a 9 out of 10. The bad news cascaded. The cancer had traveled to his lymph nodes. The doctors told Milken to get his affairs in order.

Instead, Milken did what many educated, wealthy people do: He networked. A friend recommended he see Dr. Stuart ``Skip'' Holden, a urological oncologist at Cedars-Sinai Medical Center in Los Angeles. Another friend, Dr. Neal Kassell, a neurosurgeon at the University of Virginia, suggested talking to Dr. Andrew von Eschenbach, then director of prostate cancer research at the University of Texas M.D. Anderson Cancer Center in Houston. Dr. Eschenbach was studying men who had cancer in their lymph nodes but not in their bones -- Milken's situation exactly.

Major Donor

Soon, Holden put Milken on hormone-deprivation therapy to starve his cancer of testosterone. Then he had Milken's prostate and pelvic lymph nodes radiated over the course of eight weeks. Milken adopted a strict diet. He avoided saturated fats found in meat and began eating more soy. His PSA dropped to zero. Today, he's still in remission.

``I wouldn't be here today if it wasn't for PSA,'' Milken says, sipping a purple smoothie containing -- among other things -- pomegranate juice, soy protein, lemon zest, selenium, blueberries, vitamin E and green tea, all reputed cancer fighters.

His Prostate Cancer Foundation has given money to more than 1,200 researchers, many of them working on ideas that are too far out for other charities to support.

This year, the foundation reassessed its priorities and decided to focus on two things: finding a blood test or other biomarker that gives more clues about prostate cancer's progression than PSA does and getting more drugs into human trials, especially for cancers that return.

``Where we have been really stuck is in effective treatment for men with recurrent disease,'' says Leslie Michelson, the head of the Prostate Cancer Foundation.

All Clear

All of the men in this story remain cancer free. Weinstein, like Milken, is trying to avoid a recurrence by watching what he eats. Weinstein has adopted a mostly vegan diet. He avoids fats, except for olive oil, and takes green tea extract, milk thistle, saw palmetto and selenium, all reputed cancer fighters.

Lewis takes selenium and lycopene, a substance found in tomatoes. He and Jutta built their house in Carmel, and Lewis finished his book, ``The Power of Productivity: Wealth, Poverty, and the Threat to Global Stability'' (University of Chicago Press, 370 pages, $28). They split their time between Washington, D.C., and California. The new house abuts wilderness, which Bill plans to explore. He still gets annual biopsies and twice-yearly PSA tests with Carter at Johns Hopkins.

Hurley got his first post-HIFU PSA test recently and it was a scant 0.2. His reading indicates that the cancer is gone. Prostate cancer can return years later, usually in the lymph nodes or bones, even after a prostatectomy. Nerve-sparing HIFU can leave some prostate tissue behind. The upside is that Hurley is continent and potent, no Viagra needed.

Ruby and Diamonds

Bigg is back in the pool. He was set to compete 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.

Five men, five stories. No two are alike. Every man who confronts prostate cancer -- and there will be many -- faces decisions no one else can make.

``The medical community didn't have a clear-cut recommendation for me,'' Lewis says. ``You have to take the management of your disease into your own hands.''

These men did, and so far, it's paid off.

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