Posts filed under 'PSA'
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
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 have often suggested going to local health fairs as a prudent step for those who either can’t afford a physical with a blood workup or, like so many, can’t seem to find the time in their busy lives to sit in a doctor’s office for an hour past the appointed appointment time, only to sit in an exam room for another half hour and finally to have a doctor come in and chat for a few minutes and announce that he would like you to go the local lab where they will get blood specimens. Back to another waiting room.
Health fairs are cool. You get up on a Saturday morning and go, usually, to a local school where it appears every nurse in the county has shown up to draw blood. You don’t get the friendly chat with a doctor, but you also don’t sit and wait. My experience has always been in, do the business, and out in half an hour at the most. A few weeks later they send your results.
Below is the result of this years labs. Note that they also provide a review of your last labs done through them so you have a baseline. Yes, I know I missed a year. My wife and I were on a 10th anniversary excursion in 2007.
my-latest-labs
While they is some really great news. My PSA remains low and has actually gone down slightly. My glucose is well within normal limits so it would appear I may not be crashing in on diabetes, and I once again beat my wife on total cholesterol. I didn’t win that category by much though and her good cholesterol, HDL, was higher so her ratio was lower than mine.
The bad news came for me right at the bottom. My TSH was elevated two years ago and is significantly higher now, nearing twice the normal limit. So, what I ask is a TSH? Quoting from the handy “What the heck it that quide” sent with my results, it said “TSH (Thyroid Simulating Hormone) is the pituitary hormone that controls thyroid function…..when the thyroid gland is underproducing…..TSH increases. They actually used the word “failed”, but underproducing made me feel better while I called my doctor and asked for the first open appointment.
So, from a life insurance standpoint I am still a pretty acceptable risk. Great liver functions. Great cholesterol and gluocse. My alkaline phosphatase that was high two years ago is now normal.
Bottom line. The whole reason I beat this health fair drum is that it is an easy, inexpensive way to get a checkup that could catch something serious, early.
May 12th, 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
I have often written about the surprises that come with life insurance exam results, from the fairly benign slight elevations in cholesterol to the alarming large elevations in PSA results. The surprise should really come as no surprise because the person who gets annual physicals is today, more the exception than the rule.
We all have busy schedules and for those without health insurance, the idea of “wasting” a few hundred dollars on a physical when we feel just fine just doesn’t seem to make sense. The problem is that the insidious side of health issues is that, quite often, you can feel just fine until you don’t and then it’s too late. Remember, with the big problems like cancer and heart disease, caught early is the key to beating it.
This is where health fairs bridge the gap. I know Colorado is not an exception and that health fairs are held all over the country. Their goal is to offer a way to skirt the excuses and get a health check that could find something early and help save lives. They generally happen on the weekend, away from busy schedules, and they run the gamut from free to cheap for a tremendous amount of information.
Next weekend is the health fair in our area and as always, my wife and I will attend. While I’m not shy about beating up the general population over their willingness to ignore annual physicals, the truth is that I am part of the general population. Our annual health fair has helped me to be more proactive about health where I too would be among those who really don’t want to shell out hundreds of dollars for blood tests.
Bottom line. Feeling good and being healthy aren’t necessarily synonymous. An annual checkup is a great idea and with health fairs, schedules and economics don’t have to be barriers. Don’t get surprised on a life insurance exam when you can be on top of things and know going in what the state of your health really is.
April 13th, 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
I’ve been told that all guys will get prostate cancer to some degree if they live to a moderately old age. The good news that, for many, it will have little or no impact on their lives or their mortality.
Prostate cancer that is slow growing, that is to say a low stage and grade, is quite often not treated in older men, but rather just monitored. If it ever does become more aggressive or dangerous then treatment can start and because it will be caught early in its’ aggressiveness, the treatment would likely be successful.
But let’s talk about the rest of us guys. There really is good news when it comes to prostate cancer and life insurance for the majority of cancer survivors. Especially if you get annual checkups (health fairs are great for this) prostate cancer can often be detected while it is still a very beatable illness.
If a prostate cancer is a stage T1 or T2, and a Gleason grade of no more than six (this is the majority of cases), and the psa at the time of diagnosis was less than 10 (this again is the majority of cases) better than standard rates should be attainable within a year after a prostatectomy and within two years after a radioactive seed implant. The underwriting guideline at that point would be that if they took the prostate out, your psa needs to be 0, and if they did a seed implant it needs to be .5 or less.
When you start talking about better than standard rates after cancer, that is not the norm. Getting those rates within a year or two would be completely unheard of with other types of cancer. And the key is early detection. A small price to pay for protecting your life, let alone your ability to purchase life insurance.
Bottom line. Us guys are famous for not going to the doctor when we should. Regular physicals, while I’ve heard that as high as 50% get them, really aren’t the norm. I think the guys that responded to that survey are counting every time they see the doctor for a cold and get their blood pressure taken. This is one of the reasons that women outlive us and pay less for life insurance. So get serious about your health. Go to that health fair. See your doctor for something other than your annual cold sympathy visit.
February 29th, 2008
I was visiting with a person Friday about his experience applying for life insurance through a “mega agency”. He applied last August and ran into an issue with an elevated PSA on his labs. The company postponed the application until he had a urologist’s workup, including a biopsy to rule out prostate cancer.
This person complied and had the biopsy and provided the negative results to the company and has now not heard from the agent, agency or company in over two months. No approval or decline. Just nothing.
I know I’ve ragged on the big on line agencies before and suggested that a person is better served by an independent agent. The situation above is just another example about how bigger isn’t better. Not getting an approval, even with the new results is possible, but not informing your client as to the end result is not acceptable. Not shopping it and keeping your client informed as to how things are going is not acceptable. Being too busy or too big to provide personal service is, well, too big offering bad service.
Compare that experience with the standard protocol in our office. Once an application starts, the client hears from either the agent or the staff weekly until the policy is declined or in force. If it is declined and it is shoppable, I stay in touch with the client weekly until we either find an offer or we exhaust all attempts.
After a policy is in force, we stay in touch annually. With most of the on line giants you will never hear from them again. That is simply unacceptable service.
Bottom line. It won’t take more time or money to use an independent agent rather than an on line behemoth. You will be served rather than sold. The advice will be purer in that most on line superstores have special contracts and favor certain companies. This doesn’t lower your price, but rather increases their commission. They may say they represent all of the big companies, but amazingly their recommendations will almost always come back to the same spot.
We have not reached a point where personal service is no longer valuable.
February 9th, 2008
Previous Posts
