I’m working on a prostate cancer life insurance case right now that really begs the question, even though the biopsy showed cancer, 13 years of watchful waiting later, is everyone sure that biopsy was accurate? Was it correct? Since the cancer was only seen in 5% of one of the ten needle cores taken, is it possible it was just that small and they actually extracted all the cancer on the biopsy?
His PSA at the time of the biopsy was .9. That wasn’t any kind of red flag, but a digital rectal exam turned up a small nodule. They biopsied the nodule and came up with a stage T2a, Gleason 6 cancer in 5% of one of the ten cores. Out of the total tissue taken for biopsy that means there were cancerous cells in .05%. So, was it real? A good pathologist would say that if the cells were present then it was real, definitely prostate cancer. But the same pathologist would be hard pressed to deny that if it was caught very early, the possibility that all of the cancer cells were removed is also real and that if 13 years later his PSA is lower than it was at the time of the biopsy, that would be a reasonable possibility.
The idea of active surveillance or watchful watchful waiting apparently sounds foolish to underwriters and I’m just not sure what part of it they don’t get. High stage and grade prostate cancer is treated through traditional methods. Where active surveillance comes in is when the cancer is low stage and grade, hence slow growing or not growing at all. There is no medical or scientific evidence that a low stage and grade prostate cancer somehow morphs into a high stage and grade disease, suddenly putting your life at risk. But the value in watchful waiting is that the cancer is identified, is not life threatening, and can then be watched for any changes. In most cases there are none, but if there is, it is still a low stage, low grade cancer and all of the normal treatments are still available and effective. In some studies the conclusion was that it was more dangerous to treat than watch and wait.
So what is gained by just standing by and watching and waiting? Quality of life. Radical prostatectomy is fairly consistent in the side effects of causing impotency and incontinence. If there is not a danger of this cancer jumping up and killing you why would you opt for something that is going to make important parts of your life a pain in the neck. A few companies agree while the rest take refuge behind outdated actuarial estimates that honestly were in place before there was any data supporting active surveillance.
Bottom line. If you’ve had a relatively low stage and grade prostate cancer, whether treated aggressively or put into a program of planned watchful waiting, and have run into problems getting life insurance, call or email me directly. My name is Ed Hinerman. Let’s talk.