Posts filed under 'PSA'
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
A question that comes up quite often when we discuss the examination part of a life insurance application is, just what is they are looking for? They are going to take blood and urine specimens so they must be on the hunt for something! I think the best way to answer that question is to say that they are really looking for the tip of the iceberg.
Occasionally something big shows up on an insurance exam, something that the client had no idea about. Occasionally lives are saved because people who never really got physicals got an insurance exam that tipped them off to a dangerous situation.
For example, a client had an hbA1c of 11.5 on his labs. He had no idea that he had diabetes and with that lab result, he wasn’t just borderline, he was dangerously diabetic. He went straight to the doctor and 9 months later he had his diabetes well controlled and was able to get a good price on life insurance.
It is fairly common for a person to find out their PSA is elevated for the first time on an insurance exam. Many clients who would not have otherwise seen a doctor, took those results to the doctor and found out they had prostate cancer. Many of those have come back post treatment to get affordable life insurance.
Recently a person who had been treated for prostate cancer applied for insurance and on his exam he had a slightly elevated PSA. Since his treatment was a radical prostatectomy, there should never be a detectable PSA again. He has since found out that the treatment wasn’t successful and his cancer was starting to come back.
Many clients find out that they have elevated cholesterol for the first time on their insurance exam. Another common occurrence is the discovery of elevated liver functions.
The tip of the iceberg for most. A problem discovered early enough that people were able to take corrective action and in many cases, save their lives. So, back to the question about what they test for. I have attached a set of labs from an insurance exam.
labs.pdf
Most of what you see is the normal stuff. In addition to what your doctor might run in a general physical, insurance companies also test for HIV, nicotine and drugs.
Bottom line. Insurance underwriters are looking for the obvious full blown health problems, but mostly what they find is the first clue that a problem might be brewing.
August 31st, 2007
When it comes to reasons why life insurance quotes change, right up there with being 10 pounds off on knowing your true weight, is not having a clue what your cholesterol is and finding out on the exam that it’s out of whack.
So what’s the fuss with cholesterol? Growing up in the 60’s and 70’s you never heard anyone talk about high cholesterol. Of course people were falling over left and right due to heart attacks, but back then we all assumed that there must just be some major flaw in hearts in general. People with flawed hearts had attacks and if you didn’t have a flaw, you didn’t.
The whole concept of cholesterol, good cholesterol (hdl), bad cholesterol (ldl) and triglycerides (MCBS, multiple cheeseburger syndrome) caught us all off guard. It was no longer a genetic flaw in our heart, but rather our own behavior, or a genetic predisposition to out of whack lipids that was causing our hearts to, well, just stop.
Life insurance underwriters didn’t miss this one. Remember, the life insurance business is all about risk estimation and with cholesterol it became something of a no brainer. If your cholesterol was high and your good cholesterol was too low to offset it, your chances of having a heart attack were significantly higher.
Obviously the American Heart Association has a few things to say about cholesterol. It seems for them, and I guess it’s obvious, the best thing you can do is keep track of it (yes guys, that means we have to get checkups).
The great thing is that our country is riddled with easy to use health fairs. No doctor, usually no appointment and once a year you can find out where all of your labs stand. Knowing that your cholesterol is creeping up before it gets too high can actually keep you from having to medically treat it. Often a change of diet, or some moderate exercise, or some needed weight loss will bring those numbers right back into line.
How much do you know about cholesterol? Take this quick quiz from the American Heart Association. You might be surprised.
What does elevated cholesterol mean to your life insurance rates? Just a quick sample of rates for a 50 year old guy. Applying for $250,000 of 20 year term we will assume that the only thing out of whack is his total cholesterol. No other risk factors. I will use a middle of the road company in the cholesterol corner, Banner Life.
1. Cholesterol under 220, rate is $515 annually
2. Cholesterol over 220, under 250, rate is $612 annually
3. cholesterol over 250, under 280, rate is $795 annually
4. Cholesterol over 280, under 300, rate is $927 annually
Bottom line. Cholesterol, like any other risk factor such as blood pressure, glucose, or PSA are worthy of an occasional check. Might just keep you around longer. Also, if you have borderline high cholesterol or treated cholesterol, don’t go to your local American Family or Farmer’s agent for life insurance. You need an independent agent to guide you to the best rates.
August 28th, 2007
I know when my father was undergoing radiation treatment for his bladder cancer, I was amazed at the computerized system they had for aiming the radiation exactly where they needed it. One of the down sides to the whole system is the fact that, inspite of the best effort on the part of the patient and doctor, movement can occur. When precision is a necessity, movement is the enemy.
There is now a system being used in the treatment of prostate cancer that can make automatic adjustments to compensate for small movements. Hopefully this type of system will be available for larger target cancers before long.
It is innovations like this that will make treatment more effective and anytime treatment is more effective, the end result is more acceptable to a life insurance underwriter.
Of course radiation is just one option for prostate cancer treatment. Depending on the aggressiveness of the cancer when it is diagnosed, determined by the stage and grade of the cancer, the treating physician may recommend a radical prostatectomy (removal of the prostate), radioactive seed implant, radiation (as described above), or hormone therapy. An option that is being looked at more frequently with older men is to just watch and wait . In many cases, no treatment is OK as long as the cancer is in a fairly slow progression mode. In all likelihood, the patient would not succumb to the cancer, but at an advanced age, would pass away from some other cause.
Bottom line. Get regular checkups that include a prostate exam and psa test. Keep copies of all test results if you are diagnosed with prostate cancer, or really with any type of cancer. Those test results are invaluable when your independent agent is shopping for competitive life insurance rates.
August 27th, 2007
I’ve been accused of harping on some subjects, but I will never be accused of glossing something over or falling short of driving a point home. In our own health, as well as in our quest for lower life insurance rates, knowledge of our own health and educating ourselves as to our health risks is critical. If you don’t know your enemy and how to recognize it, how can you possibly expect to avoid it.
There’s a new game show on TV called the Power of 10. In this show contestants try to guess the percentage of Americans that believe some statement or another. Just as an example, they asked what percentage of Americans would rather watch a hot dog eating contest than a presidential debate. The results are always a little surprising.
Well, if the question were posed, are women more likely to know their weight in high school than their current cholesterol level, what would you think? A news story a few days ago answered that question, and you guessed it….I would not have brought it up if it wasn’t significant and knowing your weight in high school isn’t what I would call significant in the whole scheme of things relating to your health.
Just so you know 79% of women knew their weight in high school and 33% of women knew at least one of the four components of their lipid profile, total cholesterol, hdl, ldl and triglycerides.
In all fairness, while I haven’t seen any studies, I doubt that the average man knows their PSA level, a primary warning sign for the detection of prostate cancer. With free health fairs blanketing our country, their truly is no reason for men or women not to be aware of and on top of the warning signs for major risk factors.
The number one cause of death in women is heart disease. Knowing your cholesterol is important.
Bottom line. Avoiding serious health issues doesn’t just happen. Detecting health problems before they become dangerous takes a little effort. With health fairs, it’s not even a money issue. It’s all about caring and taking the time.
August 24th, 2007
There is no more critical component of life insurance underwriting of prostate cancer than the stage and grade. In the medical world it is often next to impossible to find a simple explanation of anything. I found an article today that explains the whole prostate cancer diagnosis process as simply (and accurately) as I have ever seen.
The article lays out in layman’s language what doctor’s are looking for, how they grade it when they find it, and what it means for you.
Remember that the factors underwriters are looking at is the PSA at the time of diagnosis, the TN stage of the cancer, the Gleason score or grade of the cancer, and the PSA after treatment. The post treatment PSA may differ depending on the treatment chosen. A prostatectomy should result in a PSA of 0 and that is the underwriting goal. If a seed implant is used, once the PSA has been at .5 or less for a year, better than standard rates can apply.
Bottom line. Know your cancer. Know the numbers and seek out an independent agent who is well versed at working with prostate cancer.
August 15th, 2007
As older guys we are all familiar with the whole issue about prostate cancer. Our doctors like to check us annually just like our wives get annual pap smears or mammogram to rule out cervical or breast cancer. I’m sure women would say we are getting off easy when all we have to do is get a “digital exam” and a blood test to check our PSA. Life insurance underwriters like to know that we get this done on a regular basis.
One of the indicators of the onset of prostate cancer is a PSA that is elevating. A normal PSA would be between 1 and 4. It will gradually rise with age. What doctors watch for is a more than gradual elevation. When we get to that age where we start getting an enlarged prostate, benign prostatic hypertrophy (BPH), it is not uncommon for your PSA to raise more than gradually.
It is at this point that many doctors suggest a prostate biopsy to rule out cancer. While not a new idea, another test for “free” PSA, may lead to the conclusion that the elevation in PSA is not cause for a cancer concern, but rather would lead to the conclusion that a person should be treated for BPH and then monitored for any future changes.
Proponents of the free PSA test say this will do away with many unnecessary biopsies, a procedure that has the same inherent risk of infection that any invasive procedure has. Opponents say that any risk of prostate cancer is worthy of a biopsy. Better safe than sorry.
Bottom line. If your doctor suggests biopsy and has not done a free PSA test, ask if you can have one done. Always feel free to get a second opinion. Having said that, don’t get mired down in the debate. The truth is that prostate cancer caught early gives you a better chance of beating it and a better chance of getting life insurance rates that are fair, post cancer.
August 15th, 2007
When it comes to life insurance underwriting of breast cancer, well really for any cancer, the earlier it is diagnosed the better the chances of getting good life insurance rates. But even better, it increases your chances of winning the battle.
I’ve talked often about the direct link between the stage and grade of a cancer and the outcome of life insurance underwriting. The earlier it is caught, the lower the stage and grade. Another way of stating that is that when detected early, the cancer generally hasn’t spread and hasn’t become aggressive.
An ABC News article a few days ago reviewed the American Cancer Society guidelines for early detection of breast cancer. Whether it is these guidelines that are followed for breast cancer detection, or PSA tests and physical examination of the prostate for prostate cancer, or colonoscopies for colon cancer, many opportunities to catch cancer before it becomes deadly are just not pursued. They should be.
Bottom line. If you don’t care about life insurance rates, be proactive about early detection of cancer to save your life. Your family will appreciate it.
August 5th, 2007
According to the Prostate Cancer Research Institute about 220,000 new cases of prostate cancer will be diagnosed this year. About half of those will choose to have seed implant therapy, also called brachytherapy. Life insurance underwriters have a slightly different set of guidelines for determining how to treat seed implant therapy as opposed to other treatments such as a radical prostatectomy.
Seed implant treatment is one of the options for a lower stage, usually stage 1 or 2, and a low to moderate grade, Gleason 4 to 6, prostate cancer. According to Prostate Cancer Research Institute, seed implants are gaining in popularity ” due to (1) the fact that five- and ten-year disease control rates of brachytherapy equal those of the top surgical and radiation series, (2) the toxicity and side-effects are perceived to be lower, and (3) the brachytherapy involves just a single outpatient treatment.”
Life insurance underwriters look at the same factors in the beginning no matter what treatment course is chosen. Usually a low stage and low grade prostate cancer as described above, coupled with a diagnosis level PSA of 10 or below, can expect better than standard rates from several companies as long as the treatment results achieve results that fall within certain guidelines.
With a radical prostatectomy the desired treatment result is a PSA of 0. Absence of the prostate should have this result. With brachytherapy underwriters want to see the PSA at .5 or below. I have been following a case for the last six months. At the time of diagnosis his PSA was 5.3. In January he had a seed implant. We spoke today and his PSA is .48. Time to start shopping for the rates he wants to lock in.
When you have a cancer with a Gleason grade 7, the underwriters will still likely appove your insurance, but they will usually add an extra charge to the policy for several years due to the perceived increased risk. I have likened the underwriting difference between Gleason 6 and 7 in the past, to the Richter scale for earthquakes. On the Richter scale a 6 will shake everything up real good and a 7 will knock a lot of things down. When the Richter scale measures an earthquake at 8, there is mass devastation.
Bottom line. Get your information together. Know your diagnosis level PSA, your post treatment PSA, and if you don’t know the stage and grade of your prostate cancer, get a copy of your pathology report. Find an independent agent with experience in shopping prostate cancer cases. It is a matter of matching the medical information to the right company and underwriting to get you the best possible prices.
July 26th, 2007
The very thought of trying to find life insurance for someone who has had prostate cancer would send 98% of life insurance agents screaming into the dark. Most would just tell you, without asking any questions, that you are uninsurable.
About 80% of prostate cancer cases are not only insurable, but insurable at rates that someone with no cancer history would be happy with. If you want to win the prize there are three things that your agent should ask for and you need to be able to provide. If the agent doesn’t ask for these things, get another agent.
1. You need to know what the doctor found when you were diagnosed! Their first indication was probably an elevated PSA ( prostate specific antigen). You need to know what that was at the time of diagnosis. From there they would have done a biopsy. From the biopsy they would have determined a stage and grade of the cancer. The stage would be somewhere between A-D. It could be like A2. The grade, also known as the Gleason score would be two numbers added together, such as Gleason 3+3=6. Keep a copy of your pathology report. These numbers become fuzzy with age, but will mean just as much to an underwriter 5 or 10 years down the road as they do 1 year after the cancer has been stopped.
2. Know when your treatment was completed and what your current PSA is. Most companies will want you to be some period of time post treatment, at least six months to a year, and they will want to see that your treatment has achieved the optimal result. As an example, if your prostate was removed, a radical prostatectomy, your PSA should be a statistical 0. If your treatment was by radioactive seed implant, a PSA of up to .5 could be the result an underwriter wants to see.
Bottom lines. If your agent doesn’t ask questions, get an independent agent who does. If you don’t know the information I just reviewed, find it out and get a copy of your pathology report while you researching. Don’t ever let an agent tell you your situation is uninsurable.
July 16th, 2007
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