Posts filed under 'PSA'
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
In a post a few days ago concerning the practice of “watchful waiting” that is used in low stage, low grade prostate cancer, I offered to poll several life insurance companies to see how they felt about the practice from a life insurance risk standpoint.
The question really comes down to this. Is watchful waiting a treatment? We know that companies like Prudential underwrite low stage and grade prostate cancer very aggressively if it is traditionally treated and the results are the expected results. For instance, with a radical prostatectomy, the PSA goes down to 0 and stays there.
Here are the results from the first 5 companies that responded to the question, “is there a situation or an age at which watchful waiting would provide an acceptable life insurance risk?” For the purpose of the question, I used a Gleason grade 6 and a T1 stage.
Prucential - Quote Declined. Sorry, unable to consider watchful waiting with a Gleason 6 cancer.
ING Reliastar - Cannot consider at any age until treated with prostatectomy or radiation
Met Life - Regret we would make no offer on a watchful waiting case
American General - Would not offer coverage on untreated prostate cancer
Genworth - We would make no offfer at any age
I think I’m seeing a pattern here. Not an unreasonable pattern, but nevertheless, a pattern that put’s the cancer victim in something of a quandary. On the one side they have their trusted physician making a prudent recommendation based on the best medical knowledge. If there is a chance that the cancer will never need to be treated, watchful waiting makes sense.
On the other side, a life insurance underwriter is stuck with evaluating a risk based on the outcome of treatment. There are some risks that they will accept at higher rates without conclusive treatment. High cholesterol and high blood pressure come to mind. But, even though the odds are in the prostate cancer patient’s favor with watchful waiting, it’s a little tough for an underwriter to fully embrace an untreated cancer that can kill you and kills tens of thousands annually.
Bottom line. The good news for those in this Catch 22 is that, if you and your doctor have chosen watchful waiting, you are likely not going to die from the cancer. The unfortunate news is that, even though the cancer doesn’t appear to be a mortality risk, you can’t get the insurance that would cover other possible causes of death. Unlike health insurance, you can’t exclude cancer and have everything else covered.
January 29th, 2008
With localized prostate cancer the treatments of choice have generally been radioactive beam, radiactive seed or prostatectomy. All are very effective in stopping a low stage cancer. Effectiveness comes with side effects though.
Incontinence and impotency are the most common side effects of all three treatments. There is a newer treatment called high intensity focused ultrasound (HIFU) that has been tested more extensively in the UK. While not yet fully accepted, the first 5 year survival studies are out and the rate is about 80%, with fewer side effects.
These numbers put HIFU on the same plane as radiotherapy from a survival standpoint. HIFU treatment had been on the chopping block, doomed to be relegated to clinical trials only until this study. This will likely push it toward mainstream treatment.
Bottom line. A low stage, low grade prostate cancer, successfully treated will generally lead to better than standard rates as long as the PSA reaches certain threshholds. With radiotherapy, the PSA needs to reach .5 and remain at or below .5 for a year. I would expect the same guidelines will be applied to HIFU.
December 6th, 2007
PSA (Prostate Specific Antigen) tests have long been the standard test for determining BPH (enlarged prostate), Prostatitis (infection of the prostate) and prostate cancer. There are two events that are watched for.
The event that far too many people experience is when they are not being tested on at least an annual basis and when they do get tested, their PSA is substantially above normal. If a PSA is not changing, an acceptable normal level would be between 0 and 4. In the scenario above, finding a PSA that has always been in the normal range suddently out of the normal range would require further immediate testing to determine the cause.
The other event has to do with what is called PSA velocity. This is normally seen when the PSA is still within the normal range, but begins to increase on a regular basis. Generally if your PSA starts to increase a doctor will encourage more frequent PSA tests. Monitoring in this manner will allow you to avoid unnecessary invasive testing such as needle biopsies. Often, with BPH or prostatitis, the PSA will rise and level off, or rise and fall.
If a PSA continues to steadily rise, even if it is still within the normal range it is often recommended to check for cancer through a biopsy. The good news in those cases where the PSA velocity is slow is that if it is determined that cancer is present, it is generally an early stage, low grade cancer. When diagnosed at this level, prostate cancer has more treatment options and has a better overall prognosis.
When prostate cancer becomes more dangerous is when regular testing is not done and the cancer is not found until it has spread.
From a life insurance standpoint prostate cancer is ultimately insurable at very good rates as long as the cancer is diagnosed at early stages and low grades, and treatment is successful. There is generally a waiting period after the treatment just to ensure that the planned outcome is on track, but, if your PSA has returned to the appropriate level within a year post treatment, you should review your situation with an independent life insurance agent.
Bottom line. Follow the guidelines for testing. Learn more about prostate cancer and life insurance underwriting at our new website. If you have a family history of prostate cancer you should begin annual testing no later than age 40 and earlier certainly makes sense if there are multiple incidences in your family. Any man over age 50 should have annual reviews of their PSA and yes guys, a digital exam.
December 3rd, 2007
The Prostate Cancer Foundation has an annual scientific retreat where the top research scientists get together and review and summarize the major breakthroughs of the year. The Foundation provided a summary this week that, thank you, offered the summaries in language that would excite a scientist, and a separate summary that helps us normal folks understand what the heck they were trying to say.
Just a few of the highlights that I believe we can draw hope from was the discovery of chromosomal fusion. In a nutshell, knowing that this DNA change takes place at the very beginning of the formation of prostate cancer may offer new ways to test for early onset. Previously we had to wait until there was some change in the PSA and often, by the time the PSA showed a significant enough change to warrant further testing, the cancer was advanced. By testing for chromosomal fusion, tests such urinalysis could be used to determine if any DNA shifting had occurred.
While the conclusion was that further study is needed, there is growing evidence that lifestyle may play a key role, and specifically the way food is prepared. Our Cajun friends will not be happy with this, but it seems there is a link between charred (blackened) meats that cause a major dietary cancer-causing chemical (carcinogen) called PhiP, to settle in the prostate.
And finally, nanotechnology, the microscopic delivery of cancer fighting drugs to nano specific areas is gaining momentum. Each new step that can help deliver the needed drug to the specific target is a step toward improved treatment and ultimately improved success.
Bottom line. Prostate cancer detected early and treated correctly is ultimately survivable. These scientific breakthroughs are great news for the 1 in 6 men who develop prostate cancer, and for every prostate cancer survivor who seeks fair life insurance rates.
November 28th, 2007
No need to cringe. I’m not about to go on another tear about obesity……but I did run across a rather interesting phenomenom in an article today. The premise is that PSA readings in obese men can be falsely lower because they have a larger volume of plasma, thus “decreasing serum concentrations of soluble tumor markers - a phenomenon known as hemodilution”.
We’ve discussed plenty of issues where obesity is a contributing factor in causing collateral health issues, but this is the first time I’ve seen a study that suggests that being overweight might somehow mask a health issue.
If the theory of hemodilution is correct, obese men are at risk of not having prostate cancer detected as early as their smaller counterparts. We’ve discussed plenty of times how early detection is one of the keys to successful treatment.
Bottom line. Obesity is not your friend. It can cause or compound numerous health issues and make the whole issue of getting life insurance far more complicated than it needs to be.
November 21st, 2007
In all the study and writing we’ve done on the subject of prostate cancer, we’ve uncovered some interesting little tidbits. In an article I cited in a recent post they claimed that 30% of men in their 30’s had prostate cancer at some level. Another study cited some time ago stated that all men will have prostate cancer at some point in their life.
Well, I haven’t found anything to back up the claim about men in their 30’s, so I’m thinking that was actually a typo or something. Maybe they meant 3% of men in their 30’s, which based on other studies I’ve seen doesn’t seem like it would be out of line. As far as all men having it at some point, that seems feasible.
Prostate cancer in most cases is not a horribly aggressive cancer and can go for many years without detection. To think that an older man might have prostate cancer that is never detected and really never contributes to their death is a reasonable assumption.
There has been an assumption of sorts for a long time that prostate cancer is a disease that primarily effects older men, guys like me in our 50’s and 60’s. A recent study in the UK seems to indicate that may not be entirely accurate.
The study involved men in their 40’s, and the percentages of elevated PSA’s and incidences of cancer were almost identical to men in their 50’s. I think it’s important to note that life insurance underwriting doesn’t focus on the age of the person as much as it does that specifics of the pathology, the stage and grade of the cancer.
Bottom line. Men with a family history of prostate cancer should probably be getting their PSA checked when they reach their 40’s and all of us older, post 50, guys should have it checked regularly. Detected early, the survival rate for prostate cancer is very good.
November 17th, 2007
The very thought of a needle biopsy of the prostate kind of makes me cringe, but if there’s a chance a person has cancer, you kind of want to know for sure. The thing that has always struck me about the needle biopsy method is that the size of the samples are small. They are also spread out because generally there isn’t a real good idea where the cancer is located.
Very often, with a mildly elevated psa, the amount and size of the cancer is miniscule. That’s really good news in that finding cancer when it is in very early stages greatly increases the chances of succesfully treating the cancer. The problem is that, being so small, it is not uncommon for a needle biopsy to miss the cancer. The doctors are pretty sure something is going on, but they aren’t likely to talk the patient into a second round of needle sticks because they couldn’t find anything the first time.
Another problem with the needle biopsy is a situation called needle tracking. This occurs when the doctor is fortunate enough to hit the cancer, thus obtaining a sample, but then drags a cancer contaminated needle back through the wall of the prostate effectively depositing what was a contained cancer outside the prostate.
There is a new diagnostic tool called an MRI-Spectroscopy (MRI-S). the non invasive procedure has shown in tests to be about 75% effective in locating prostate cancer, compared to about 30% for the random needle biopsy method. Once the cancer is located and road mapped, the needle biopsy no longer becomes random, but rather a specifically targeted removal of cancerous cells.
That still leaves the problem of “needle tracking”, but the less times a guy is poked, the less likely that the tracking will occur. Overall this seems like great news.
There was one statement in the article that begs a little more study. “In fact, data from the Detroit Autopsy Study and Memorial Sloan- Kettering shows 30% of 30 year old men have prostate cancer.” If that’s true, probably 110% of guys my age have it. I will check that statement elsewhere and bring it up again.
Bottom line. Nearly 500 men are diagnosed with prostate cancer every day. About 90 die from it every day. The earlier the cancer is detected, the higher the survival rate. From a life insurance standpoint, early detection generally will lead to a lower stage and grade of cancer. Post treatment, a low stage and grade prostate cancer is one of the more insurable cancers out there.
November 7th, 2007
Here is another area where men just don’t follow through and do the right things. Doctors say that after age 50 we should have our PSA (prostate specific antigen) checked once a year. No big deal. A little blood and a relatively inexpensive test. OK, all you guys that have done that as suggested, raise your hand! Ok….that wasn’t impressive.
Catching a rising PSA early can mean catching prostate cancer in an early stage, giving more options for treatment and better long term results. But, does an elevating PSA always mean that cancer is present or imminent? The answer to that would be no!
Medline Plus sums up the three main reasons a PSA can be elevated. Keep in mind that PSA can change from day to day as PSA is released into the blood whenever a prostate cell dies. This can occur with an infection (prostatitis), an enlarged prostate (BPH) or with prostate cancer.
I’ve always been told that a normal PSA is between 0 and 4. I think mine was .6 the last time it was checked. Doctors don’t seem to be as concerned with “normal” as they are with increases. I have had clients diagnosed with prostate cancer because their doctor did a biopsy when their PSA went from 1.0 to 2.4 in one year.
Evanston Northwestern Healthcare suggested in an article that the PSA can fluctuate as much as 20% a day. It seems the key word there is fluctuation, which would seem to indicate up and down, as opposed to just up.
From a life insurance underwriting perspective, out of normal is the most common red flag that is found. Many men, as I mentioned in the beginning, don’t bother to have their PSA checked, so they find out about the problem on an insurance exam. If you have an abnormal PSA on an insurance exam, expect to be put on hold while it is evaluated by your doctor. If, after testing, it is found to be prostatitis or BPH, and treatment successfully lowers the PSA, you are back in the game.
If it turns out that the elevation was due to cancer, depending on the stage and grade of the cancer, you could be back in the hunt as soon as a year after treatment. Often better than standard rates can be had after treatment.
Bottom line. Prostate cancer is the second most lethal cancer for men in the United States. It is very survivable if caught early, but you don’t catch it early by applying for life insurance every 10 years or so.
September 21st, 2007
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