Posts filed under 'prostate cancer'
As soon as you tell someone that they don’t qualify for the best rates available, stand back, because the knee jerk reaction is to unload on you with something akin to the intelligent response, “So, they think I’m about to die of a heart attack, or what?”
First, let’s get a grip. If an insurance company thinks you are about to die they most assuredly aren’t going to offer any coverage at all, and they will probably have your agent contact you and suggest that you see your doctor sooner rather than later. I think every agent who’s been around for a while has run into a client, or a several, who has lab results come back that need immediate attention.
Just to recall a few I had a client who’s PSA on his labs was 35 and yes he did have prostate cancer but didn’t know it until it was suggested he see his doctor. I’ve had plenty of clients whose blood pressure was in the ridiculous range and they didn’t know they had a problem until we did an exam. By the way, a common theme here is that these people generally don’t get regular physicals. Another client was profoundly diabetic with an hbA1c of 11.9. After a year of treatment his diabetes was controlled enough to get the life insurance he wanted.
Mortality risk is the measure that insurance companies use to determine what rate class to approve you in, but if you don’t fall into the best mortality risk rate class it doesn’t mean that you should be saying adios to your loved ones.
Everyone is in love with the best rates available. I have long since fallen from that lofty level of health from an underwriting standpoint even though my doctor would swear to you that I’m in great shape for someone my age. All it took to bump me from preferred plus rates down to standard plus or standard was a silly thing called Raynauds. Raynauds by itself is not really a mortality issue but rather more of a pain in the rear issue. It causes my fingers and toes to change color and lose circulation when I get cold, or even just cool.
From an underwriting standpoint I have been told that Raynauds in and of itself is not a big issue except that it can be the first symptom of a larger and more deadly issue, CREST syndrome. I have addressed the issue with underwriters to the best of my ability and have not been able to convince them that while Raynauds can in fact be the first symptom of CREST, it generally doesn’t remain the first symptom for 25+ years.
Bottom line. Life insurance underwriting can’t be compared to medical evaluation. Underwriters and doctors and like men and women. They may both be good at what they do, but for the life of them they can’t figure out why the other one can’t see it their way.
November 11th, 2008
Assuming survival, which is a pretty good bet with prostate cancer, a life insurance underwriter uses a set of criteria to evaluate the mortality risk of any given cancer survivor. It is this assessed risk that is translated into a rate per thousand dollars worth of insurance that a person must pay to be covered.
Prostate cancer is the second most prevalent cancer in men with nearly 250,000 men being diagnosed each year. The good news is that only about 1 in 37 men actually die from the cancer. Since most prostate cancer is confined to the prostate gland, and the most common treatment is removal of the gland, the survival rate is very high.
Life insurance underwriters look at prostate cancer from a couple of perspectives, and each of those is given a different spin depending on treatment options chosen. Optimally, a man should be able to get standard or better rates in most cases a year after successful treatment.
Underwriters first look at the PSA (prostate specific antigen) at the time of diagnosis. It varies from company to company, but for the best underwriting the PSA at the time of diagnosis should be 10 or under. Under 4 is considered normal. A PSA higher than 10 usually indicates either a faster growing cancer or someone who has not actively monitored their PSA.
The other factor that is critical is the grade of the cancer as indicated by the Gleason score. For the best consideration the pathology report should indicate a grade of no more than 6. I’ve compared the Gleason grade to the Richter scale in the past. A Gleason grade of 6 is very insurable in most cases, a 7 only at very high rates and an 8 or above usually not at all.
So, assuming a diagnosis level PSA of less than 10 and a Gleason 6, the last factor underwriters look at is the post treatment PSA. With a radical prostatectomy, the surgical removal of the prostate, a PSA of 0 is the expected result. If after one year the PSA is still at 0, standard or better rates should be available. The other primary treatment is radioactive seed implant. Rather than removing the prostate, one or more radioactive seeds are implanted in the prostate effectively killing the cancer cells. With this treatment, since the prostate is still there, a PSA that has been at .5 or lower for at least a year is the underwriting goal.
Bottom line. Prostate cancer is highly survivable and is also very insurable in most cases. If you have had prostate cancer and are looking for life insurance, seek out a knowledgeable independent agent and come armed with the knowledge of the different factors that will be scrutinized.
August 6th, 2008
Guys, we’ve talked about this before, an area where women don’t even have to struggle at all to make us look like morons. Unfortunately far too many men find out the value of an annual physical, a regular checkup, when they discover that they have a serious health issue that might have been avoided or at least discovered earlier if they had a relationship with their primary care doctor.
I don’t have to search far to find the truth in this. In just the last 10 years, the number of men who have applied for life insurance through me only to get declined because of medical information they should have known has been, well, larger than most men would guess. The medical exam and lab tests that come with applying for life insurance are quite often the first thorough workup men have had in years. To their dismay it often answers the question about why they haven’t been feeling up to par lately.
All of these things are simple and relatively inexpensive to test for when you consider the high expense of treating the aftermath when things get out of control. Probably the most common thing that pops up is high cholesterol, a leading cause of heart disease. Caught early, minor lifestyle changes can usually turn the problem around. When the problem is discovered after things are out of control, it is often a far more serious matter.
Diabetes is a fairly common discovery on insurance exams. Again, any kind of regular checkup would have revealed a level of pre diabetes that could have been treated with lifestyle changes. It is not an unusual occurrence for men to discover that they have prostate cancer due to an elevated PSA on their insurance exam.
One issue that pops up with regularity that doesn’t even require an exam is the discovery that both men and women find out that they weigh significantly more than they thought they did.
All of that is to say that having regular visits to your doctor, for obvious reasons, is something that insurance companies like to see. It is safe to say that the majority of life insurance companies, if you are over age 50, would prefer not to even consider your application if you haven’t seen the doctor in the last 2 years. There is only one company I know of who will consider your application under those conditions if you are over 60.
Bottom line. Guys would prefer not to see doctors unless they are dying. This really presents a poor risk to insurance companies. Since insurance companies aren’t likely to change, men, maybe we should consider conceding to women that they are right on this issue.
August 4th, 2008
Because of the exceptionally high success rate in treatment of prostate cancer, it stands out as ultimately one of the most insurable cancer histories from a life insurance underwriting view.
Prostate cancer is the second most commonly diagnosed cancer among men, but it has often been said that virtually all men who live to an old age will have prostate cancer to some degree. Very often it goes undiagnosed because it is a slow growing cancer and most men who have it will die from something else never knowing it was there. Having said that, about 1 in 35 who have been diagnosed will die from the disease.
Life insurance underwriters are forever focused on “mortality experience”, and the good news with prostate cancer is that experience is very favorable. Because of more aggressive education and screening and improved treatment, the chances of surviving a diagnosis of prostate cancer is very much in your favor. The key is screening.
For the most favorable life insurance outcome early detection’s importance can’t be overstated. Underwriters want to see diagnosis with an early stage (1 or 2) and a low to moderate grade (no more than a Gleason grade 6), coupled with a diagnosis PSA level of usually 10-12 or less. By far the majority of prostate cancer is detected these days when the PSA starts showing consistent elevation from test to test, but is still within the normal (less than 4) range.
Cancer caught at this point will almost always meet the stage and grade criteria and will ultimately be successfully treated. The final criteria to be met is post treatment. If a person opts to have a radical prostatectomy underwriters expect that the PSA will go to 0 and once it has been there for a year, often standard or better rates can be found. If treatment is done by radioactive seed implant, the PSA threshold is .5 or below for at least a year.
As mentioned in previous posts, watchful waiting is not considered by underwriters to be treatment and anyone pursuing this completely legitimate option will be treated for insurance purposes as having untreated cancer. I have yet to find a company that will not decline to offer insurance in this instance.
Bottom line. The good news from a guy’s perspective is that, if almost all of us will have prostate cancer at some point, at least it isn’t one of the devastating killer types of cancer like lung or colon cancer where survival rates are not nearly as good. If you’ve had prostate cancer and need life insurance, seek out an independent agent to help you. Be prepared to provide a pathology report and know what your current PSA is.
June 20th, 2008
I just received the pathology report that I mentioned in yesterday’s post from the lump removed last week from my Mom’s breast. As I mentioned, with this type of cancer this report is step one of two, with a biopsy of one or more lymph nodes next week being the second half of the picture. The combination of the reports will drive the doctor’s recommendation for treatment.
From the pathology report there were three findings:
1. Infiltrating ductal carcinoma (3.2 cm) moderately differentiated (grade II/III)….
2. Focal angiolymphatic and perineural invasion noted
3. Surgical margins free of malignancy
With a bit of studying I found that infiltrating ductal carcinoma is the most common type of breast cancer and in a nutshell it is a cancer that has penetrated the milk duct walls, as opposed to in situ which has not penetrated the duct walls. Even though the cancer cells have broken through the duct walls, the cancer often remains localized. That is to say that just because it is infiltrating versus in situ doesn’t necessarily mean it is a more aggressive cancer.
Item 2 kind of caught my attention. As a layman it kind of sounded like the cancer had invaded the lymphatic system. Again, with a bit of study it seems that the wording, from a pathologist’s view really just means that the cancer has the potential to have spread to the lymphatic system. That is the reason for next week’s biopsy.
Again, if my Mom was in the life insurance market, so far the news is good. The lump was small at 3.2 cm. The surgical margins were free of malignancy. With a good lymph node biopsy next week, she could be on the road toward good rates, post treatment of course.
Bottom line. Breast cancer in women and prostate cancer in men are the types with the highest success rate for getting affordable life insurance post treatment. In a best case scenario there will be a one year waiting period after completion of treatment. The success rate with life insurance and the high survival rate are primarily due to improved screening and treatment methods.
June 18th, 2008
Last year my father, age 85, did battle with bladder cancer. He was blessed with great doctors and literally hundreds of people praying for him. Today you wouldn’t even know that he had been through a fight with a high grade, high stage cancer that takes more lives than it passes by.
Today I leave for Wyoming again. Tomorrow my mother will have a lumpectomy to remove a tumor from her breast. Again, I ask you to pray. All of the previews indicate that the cancer is contained in the lump and unless something different is found during surgery, her prognosis is good.
Breast cancer is the second most common cancer among women, as with prostate cancer in men, only second to skin cancer. With improved screening and more education about self examination, breast cancer is more commonly found these days in early stages. As with all cancers, the earlier the cancer is found the higher the survival rate.
While my Mom is 84 and not likely to be shopping for life insurance, if she were, the news would be good. A lump, or encapsulated tumor, is relatively easy to treat generally by removal of the tumor and radiation therapy. If the biopsied tumor did in fact show it was a low grade tumor and had not spread, a woman could expect that life insurance would once again become affordable as little as a year post treatment.
When you do reach that point of being ready to shop for life insurance, a few helpful hints. Pardon my broken record, but find a good independent agent with a good working knowledge of breast cancer underwriting and a good track record of results. Obtain and keep a copy of your post surgical biopsy so that the agent and the life insurance underwriters know exactly what they are dealing with and quoting. Accurate and complete information will lead to better offers and results.
Bottom line. Breast cancer is becoming more survivable each year and has made enormous strides over the past ten years in its’ treatment by life insurance companies. Start formulating a game plan with an independent agent as little as six months post treatment.
June 12th, 2008
When you apply for life insurance it is not a given that you will get what you want or what you believe you deserve. By far the majority of policies are approved with no surprises. A smaller percentage are approved but at a different rate. And a small percentage are declined by the insurance company because they perceive the risk to be unacceptable.
So why do declines happen? What are the most common reasons that a perfectly good application can result in complete rejection? What impact does a decline have on your ability to get insurance through another company?
The most common reasons are:
1. Something comes up on the lab results that neither you or the agent knew about. It has not been an uncommon occurrence for clients to find out, due to the life insurance exam, that they have prostate cancer, hepatitis, diabetes or the beginning stages of coronary artery disease (CAD). I know I blog all the time about how you can get life insurance with these conditions, but that assumes that you know about it, are treating or have treated it, and it is cured or under control. This reason for decline happens most frequently with people who don’t see the value of an occasional physical.
2. Non compliance with your doctor. For those who do visit the doctor occasionally, there is often a recommendation to have something looked into further or perhaps a recommendation to come back for a follow up in 6 months. Sometimes the doctor will give you a referral for say, a stress test or additional lab work. Plenty of folks blow those things off because they feel fine and can’t see wasting the money. Life insurance underwriters have a zero tolerance for people who don’t do what is recommended by the doctor (that they went to for a checkup and advice).
3. Stupidity. I had a client who had colon cancer about 13 years before he came to me. They removed part of his colon, did chemo and radiation, and he had not been back to a doctor since. It really kind of takes gall to even apply for life insurance with that attitude. Why would a company insure you when you don’t even care if you live?
4. Assuming that some past medical history doesn’t matter. Even though I start my relationship with every client with a health interview that starts with the preface, “Have you ever been diagnosed with or been treated for…” and ends with “Is there anything that I haven’t asked that might come up in your medical records..”, people will choose to leave something out because they don’t believe it’s relevant. When the medical records are acquired and the decline hits, the responses run along these lines. “I didn’t think anything mattered after 10 years”. “My doctor said I was as good as new after my heart surgery”. “Well, I didn’t think that was any of your business”. The quotes you receive and the end result are only as good as your honesty and forthrightness. Nothing is irrelevant until the underwriter says it is.
5. Alcohol abuse. When you drink heavily there is a high likelihood that your liver functions will be elevated. If liver functions are elevated on labs, it triggers the running of an additional test called a CDT. The CDT is an alcohol marker that, while not a diagnostic tool for alcoholism, is a very accurate test indicating whether a person is a heavy drinker. Suffice it to say that a glass of wine with dinner won’t impact your liver or show up on a CDT. A six pack a day is likely to do both.
I am often asked what impact a decline has on a person’s chances of getting insurance in the future. The answer, of course, depends. If the decline is for any of the reasons above and you don’t take care of the problem or become more honest, the result will be the same.
But often a decline by one company may get a completely different result from another company. Very often it is simply a case of the wrong agent taking your business to the wrong company. Could be that the underwriter just had an attitude or made a mistake. We are very successful at turning bad declines into good approvals. To me the nice thing about working a declined case is that all the cards are on the table and when I shop it, I know exactly what company to go to for an approval.
Bottom line. A decline on a life insurance application doesn’t mean you can’t get life insurance and many times you can end up with very reasonable rates. A good independent agent is needed simply because you want a broad range of companies to choose from and generally they will understand the steps to take with your initial bad experience.
June 11th, 2008
Guys! The boogie man isn’t under the bed, but rather right below our belly buttons, just about a finger’s length up our rear ends. I’m talking about the prostate gland and the fact that 1 in 6 men will get prostate cancer in their life time.
Prostate cancer is the second most common cancer right behind the skin cancer trio of basal cell carcinoma, squamous cell carcinoma and melanoma. While a statistically huge number of us will be diagnosed with prostate cancer, the good news is that the survival rate is very good, with only about 1 in 8 who are diagnosed actually dying from the cancer.
It is this survival rate, driven by early detection and effective treatment options, that makes prostate cancer one of the easiest for life insurance underwriting. The earlier the cancer is detected, the lower the stage and grade and the better the treatment results. With more and more men getting regular PSA tests, expect that survival rate to climb in the future. By the way, my most recent health fair results showed my PSA at .9, down from 1.1 two years earlier. Safe for now.
I’ve review a lot of articles about prostate cancer and how to avoid it. This one I read just recently is kind of like just doing what your mother said. Eat your vegetables! Sure can’t hurt and it tastes good too.
Now, back to the subject at hand. As a baseline underwriting view, if your cancer is diagnosed when the PSA is 10 or less and the biopsy shows a stage of T1 or T2 with a Gleason grade of 3+3=6 or better, depending on treatment results you could be back from the brink of uninsurable to close to standard rates in a year. That scenario would be if treatment was a radical prostatectomy and your PSA was at 0 for a year. With other treatment options the time frames can change.
Bottom line. Good news. Ultimately very survivable and very insurable. Talk to an independent life insurance agent about it today. Make sure you have a copy of your biopsy and that you know all of the relevant test results. The more information you can provide, the better the chance of finding good rates.
May 23rd, 2008
I caught the title of an article on prostate cancer out of the corner of my eye today and immediately drew the wrong conclusion. The article, “Exercise may lead to faster prostate tumor growth” drew an immediate reaction from me since I exercise daily. I started weighing the quality of my life with and without exercise and balancing that against a quicker death should I be diagnosed with prostate cancer.
Read the whole article Ed!! As I read on I learned that this test was in mice and that indeed, those that exercised daily experienced tumor growth almost twice of those that were sedentary. The conclusion was that due to increased blood flow to the tumor (and everything else), the tumor was able to grow quicker.
Still a bit up in arms, I read on. Where they were headed with this presumably bad news was in the direction of potential good news. The fact that exercise seemed to increase blood flow to prostate cancer tumors (and potentially other types of cancer as well), meant that exercise might very well deliver blood with anti cancer drugs more quickly and potently. In fact, exercise might be the key to stopping the growth of a tumor in it’s tracks.
Prostate cancer is the second most common cancer in men, but has a very good survival rate if caught early. That’s why all of us old guys get PSA tests annually. Some of you younger guys ought to consider using that as a good example and doing the same.
The other good news about prostate cancer caught at an early stage and low grade is that life insurance, a year or so out from the end of treatment, is generally available at standard or better rates. This is kind of a luxury call for a cancer survivor as most of them give some thought to the whole mortality issue after the experience, but with many kinds of cancer your chances of acquiring life insurance at affordable rates for the foreseeable future is slim to none.
Bottom line. Keep exercising. Only the mice are dying quicker from it and that is only because they didn’t treat the cancer. In the next round of tests they will be treating the cancer to see if the same exercise speeds up elimination of the tumor.
April 22nd, 2008
The PSA, prostate specific antigen, test has been the standard for decades for determining the chances of a man having prostate cancer and the need for further diagnostic testing through a needle biopsy.
The problem that has become apparent in the medical and life insurance world is that, in reality, an elevated PSA is actually not an accurate indicator for either of those assumptions. PSA levels are more frequently indicative of prostatitis, an inflammatin of the prostate, or BPH, benign prostatic hypertrophty (enlarged prostate).
Studies recently have shown that the predictive value of an elevated PSA, as it is associated with prostate cancer, is not, by many, considered strong enough to warrant the invasive needle biopsy. Scientists and physicians agree that some new marker needs to be found that can more accurately assess the need for further procedures.
From a life insurance standpoint, a new and better marker would be helpful. Many clients are postponed due to elevated PSA’s pending further investigation. At this point, with no other tests available, what they are saying is go have a biopsy and then let’s talk. The problem for the client is that they are being asked to have a test that is truly a hit or miss test in itself, along with not being risk free.
Bottom line. Anyone would want to have their prostate cancer detected early. Early detection leads to better survival and lower life insurance rates. Nobody wants to have an unnecessary needle biopsy though.
March 12th, 2008
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