Getting Life Insurance with Prostate Cancer
Grandfather, father, brother, husband, son; every man is at risk for prostate cancer. One of the inevitable problems that almost all men face as we age is our prostate begins to enlarge. For some, the enlargement of the prostate is accompanied by cancer. Luckily prostate cancer is a very treatable disease if discovered early. Prostate cancer is so treatable that life insurance companies have established health guidelines for offering life insurance to prostate cancer suffers. The health guidelines are generally established business practices. Understanding what the business practices are will increase the likelihood of a man with prostate issues getting a life insurance policy.
First, it is useful to have a basic understanding of prostate biology and a few cancer facts. However, if you are one of those afflicted, you have probably already Googled it, or talked to your doctor about it. With this basic information, it is easier to understand what life insurance companies are looking for to offer coverage to you successfully.
Over the past year in the United States, The American Cancer Society reports that 161,360 men were newly diagnosed with prostate cancer. Besides skin cancer, prostate cancer is the most common cancer to affect men. A significant factor in the probability of having prostate cancer is age. “About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40. The average age at the time of diagnosis is about 66.” (American Cancer Society, 2017) However, I will interject a personal note from my experience. I was diagnosed with a BPH or benign prostate hyperplasia at the age of 36. That is a chronically enlarged prostate. At the age of 57, I had a prostatectomy. If you are outside of the statistical probability of being diagnosed with prostate problems that does not mean you will not get them. Talk to you doctor about what is the appropriate annual health check-up and be sure to tell him if you are having problems or if there is a family history of prostate problems. A significant reason that life insurance companies are willing to offer prostate cancer patients coverage is that after treatment and at the end of five years, there is a 98.6% survival rate (NCI, SEER stat fact sheet). Although the key is recognizing the symptoms, getting diagnosed and treated.
It is important to be aware of the symptoms of problems with your prostate. Noncancerous prostate health issues present similar symptoms to cancer symptoms. Be aware if there is a decrease in your flow of urine. Is the stream as strong as it used to be? Do you feel like you fully evacuate your bladder when you urinate? Do you feel an urgency to urinate often? Is their blood in your urine or semen? Do you have pain in your groin area? (American Urological Association, 2010, A5-A6). If you have any of these symptoms, talk to your doctor, don’t wait.
The primary person that reviews life insurance applications at a life insurance company is called an underwriter. If you have prostate problems and are applying for life insurance, the underwriter will see if there is a regular pattern of health examination. Considering the pattern of health examination allows the underwriter to see when prostate problems occurred, the treatment prescribed and the advancement or recovery of the symptoms.
The next aspect to understand to help you along the life insurance application process are the most common tests that your doctor has available for analyzing and treating prostate cancer and other prostate health issues. There are several tests that may help your doctor determine the existence and prognosis of prostate cancer. For the purpose of this article we will only discuss the most prevalent test that underwriters see. If your health situation required more specialized testing, your application would be referred up to the life insurance company’s underwriting medical director for evaluation. In many life insurance companies the person filling this role will be a physician specializing in life insurance medicine. This is not a typical medical investigation. With physicians that treat patients, their goal is to improve the patient’s health. Physicians that specialize in life insurance medicine have a goal of predicting what will happen to a life insurance applicant’s health. To this end life insurance company physicians study many different medical files to find clues that will help them determine the life expectancy of life insurance applicants.
If you have a complicated medical history, you can see how confusing all the physician reports can be. If you are in that situation it may help you to retain an independent physician who specializes in life insurance medicine to communicate and advocate your health history. This is not a service that is necessary for many cases. If this is a resource that is needed, a life insurance agent should be able to help.
The DRE Test
Let’s look further at the more common prostate health test that life insurance companies will review to make a determination on an application for a man with prostate health problems.
The most common test for prostate health issues is the digital rectal exam or DRE. Your primary physician can do the DRE. The exam is quick and allows the doctor to feel if there are any lumps or nodules present as well as get a general idea of the size of the prostate. DRE’s are usually gauged as 1+, 2+, and so on.
The DRE is the first information the life insurance underwriter will look for concerning prostate health. If your medical records indicate that you have an enlarged prostate, the underwriter will investigate the treatment and progress of the issue. Age will be a factor. If you are 60 with an enlarged prostate, the underwriter will see if there are any other problems. If not, they may approve the life insurance policy with a higher rating such as preferred because an enlarged prostate is common for a 60-year-old man.
Life Insurance Policy Ratings
Higher policy ratings are more desirable because they translate into a lower cost life insurance policy. At this point, it may be helpful to review how life insurance underwriters rate policies. All life insurance companies have a rating called standard issue. Depending on the insurer, there will be two or three ratings above the standard issue. It may be called preferred, preferred plus or super preferred. Life insurance companies use several different descriptions for the top rating issues; it is not a universal terminology. Below standard there can be up to eight levels. These are called table ratings. For example, the first level below standard would be called a table one rating. Each table of one through eight increases the cost of the life insurance. There are other pricing methods however those go beyond the usefulness of this article.
The PSA Test
The second most common prostate test that life insurance underwriters look for is the prostate specific antigen test or PSA. A sample of blood is sent to a laboratory where it is tested for antigens that are unique to the prostate. Prostate antigens are a substance that the body releases to trigger its immune system. A higher level of antigens may indicate that the body is battling a prostate problem which may be cancer, but that is not certain. The PSA test is not foolproof; however, this is a primary indicator that life insurance underwriters use to determine their decisions. The normal function of the prostate is indicated by a reading of 0 – 4 nanograms per milliliter of blood. FYI, it takes about twenty drops of blood to equal one milliliter, and a nanogram is equal to one billionth of a gram. These are subtle indicators, and the PSA test is a very sensitive measure.
Since increased PSA does not automatically mean prostate cancer, a life insurance underwriter will look further at the doctor’s notes to see if there is anything else that may indicate a higher PSA such as prostatitis, an infection of the prostate or trauma to the prostate. A PSA test that is done soon after a digital prostate exam may cause the PSA test results to be higher. That is why that some doctors will recommend that patients abstain from sex and strenuous workouts for at least a day before a PSA test. Also, prior to PSA test, special precautions should be taken especially with any exercise that may irritate the prostate like bicycling or horseback riding.
A PSA test will give another number that is in a percentage format. This number is called the free PSA. The PSA that was previously discussed was the prostate specific antigen bonded by a protein to blood cells. The second PSA exist freely in the blood. The higher the levels of PSA freely existing in the blood the less likely that prostate cancer exists. So, a reading of 25% free PSA or greater is good. That means there is a lower chance of prostate cancer. However, when more of the PSA bonds with blood leaving lower percentages of PSA freely existing within the blood, that is associated with a higher probability of prostate cancer.
PSA numbers tell an underwriter a lot. If an underwriter sees a rise of PSA from one to three within a six-month period, they may postpone the issue of a life insurance policy until further testing can be done. The three is below what is considered normal; however all life insurance underwriters are cautious. A quick rise in PSA may be an indicator that something unknown is occurring within a man’s body. An underwriter may postpone approving a life insurance policy in this circumstance until more tests results are available. If you know this type of reading may raise a red flag, it would be good to ask your doctor to include a note with your medical records to explain the increase. It may help in getting the life insurance policy issued.
The Prostate Biopsy (CIRM, 04/04/2016)
Up until this point, the test that is done for prostate health does not definitively determine that a man has prostate cancer. If your doctor did not believe that further testing was necessary, this is the point where the life insurance underwriter could determine the health rating for the life insurance policy. Barring any other health issues, the underwriter will probably give the life insurance applicant one of the ratings that are higher than standard.
The existence of cancerous cells in a biopsy report is significant to consider. If a man has had or is planning to have a prostate biopsy he is not automatically excluded from getting life insurance. Let’s establish a common understanding, so you can recognize the points that are critical to obtaining life insurance after a biopsy. A prostate biopsy is where tissue is removed from the prostate to see if there are malignant cells in the prostate. When a life insurance underwriter reviews a biopsy, one of the first things they are looking for is any information that will indicate if there is the existence of precancerous or cancerous cells. The advancement of prostate cancer is broken down into four stages, and this signifies how far cancer has advanced.
Stage I. This signifies very early cancer that’s confined to microscopic particles in the prostate that can’t be felt during a DRE screening test.
Stage II. The cancer can be felt during a DRE screening test, but it remains confined to the prostate gland.
Stage III. The cancer has spread beyond the prostate to the seminal vesicles or adjoining tissue in the bladder.
Stage IV. This represents advanced cancer that has spread to lymph nodes, bones, lungs or other organs. (Mynderse, 2009)
A life insurance underwriter will consider offering life insurance to men who are in stages I and II. If prostate cancer has spread to Stage III or IV, the life insurance underwriter will decline to offer coverage until after the treatment has concluded. For men that have recovered from Stage III or IV cancer, most life insurance companies will wait at least one to five years before considering a life insurance application. That length of times largely depends on the length of the treatment.
Let’s discuss in more detail how life insurance applications may be considered when a man’s prostate tissue is considered precancerous. Depending upon the advancement of the precancerous cells, life insurance underwriters may still approve coverage. Cells in the early stage of becoming cancerous are referred to as prostatic intraepithelial neoplasia or PIN. PIN can be quantified as a low or high grade. Without any other adverse health conditions, life insurance underwriters will probably issue a standard rating to men with a low-grade PIN. A high-grade PIN will more than likely be a table four rating or the underwriter may decide to postpone issuing the policy until further testing is done. Advanced precancerous prostate cells are referred to as atypical small acinar proliferation or ASAP. Cells that are at this stage are very likely to become cancerous. At this point, the life insurance underwriter will look for references to the Gleason Score of the cells. The Gleason Score is based on the microscopic appearance that the pathologist sees under the microscope. The pathologist derives the Gleason Score by relating the appearance of the cells they are analyzing to the Gleason’s Pattern. The way that they come up with an overall grade is by examining the appearance and predominance of cells. If the most common appearance is grade 2 and the second most common grade is grade 3 they will add these together to come up with a grade 5. It is very critical to see the components of the total grade because the most common cells are listed first and the second most common cells are listed second. A total grade 7 could be 4 +3 or 3+4. The latter being a less aggressive cancer because the most common cells were grade 3.
Gleason Score (NCI, SEER training)
A total score Gleason Score between 2 and 6 is underwriteable and will more than likely get a table rating of 3 or higher. Gleason Scores of 7 and above may be underwriteable, but a lot of other factors are taken into consideration.
Life insurance underwriters will look for treatment options after considering the diagnosis from the doctor is established. There are many types of treatment for prostate cancer; watchful waiting, radiation treatments, hormonal therapy and different types of surgery just to mention a few. Once a man has been prescribed a kind of treatment, most life insurance underwriters will want to postpone offering life insurance until after treatment.
Here is a recap of the key points to help those with prostate issues qualify for life insurance. There are four primary things that most life insurance companies take into consideration in providing life insurance to customers with prostate problems or prostate cancer. First, they will consider the stage, recall that stages I and II are underwritable. Stages III and IV will be postponed until after treatment. If the applicant is within the acceptable stage or has precancerous cells, the Gleason Score is the second item that is investigated. Total scores between 2 and 6 can qualify for life insurance if there are no other health issues. Gleason Scores of 7 and above is more uncertain. The third aspect the life insurance underwriters will investigate is the type of treatment and the last date of treatment. Shorter treatments are more favorable. And finally, the PSA is considered. Remember that it is not a static number. The underwriter will look to see if PSA’s are going up and down, or are they steadily increasing or decreasing. Benign issues like prostatitis and other prostate trauma are considered in analyzing the PSA.
Hopefully, this information will help you in communicating your application for life insurance. The more clearly you communicate the information concerning your prostate health, the more likely you are at obtaining a favorable health rating and a lower cost. I have personally experienced a lot of the testing and treatment for prostate health. If I can help you with questions, please feel free to call, email or text. I will remind you that this is not intended to communicate medical health recommendations. My principal goal is to help you better communicate your prostate health condition to a life insurance underwriter in hopes of getting a favorable life insurance policy.
Posted by:
Van Richards
Van is the founder of Advice4LifeInsurance and Advice4Retirement . You can contact him at van@advice4lifeinsurance.com Follow on twitter @VanRichards or Facebook at Advice4LifeInsurance and Advice4Retirement .
References
American Cancer Society. (2017). What are the key statistics about prostate cancer? Retrieved from http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics
American Urological Association. (2010). American urological association guideline: management of benign prostatic hyperplasia. Retrieved from American Urological Association Education and Research, Inc. website: https://www.auanet.org/common/pdf/education/clinical-guidance/Benign-Prostatic-Hyperplasia.pdf Appendix A5 - A6
California’s Stem Cell Agency, & Ring, K. (2016, April 4). prostate cancer | The Stem Cellar [Web log post]. Retrieved from https://blog.cirm.ca.gov/tag/prostate-cancer/
Mynderse, L. A. (2009). Mayo clinic essential guide to prostate health[Kindle 6 version]. Rochester, MN: Mayo Clinic.
U.S. National Cancer Institute. (n.d.). SEER stat fact sheet - cancer of the prostate. Retrieved from https://seer.cancer.gov/statfacts/html/prost.html
U.S. National Cancer Institute. (n.d.). SEER training (morphology & grade). Retrieved from U.
S. National Cancer Institute website: https://training.seer.cancer.gov/prostate/abstract-code-stage/morphology.html
Gleason's Pattern