This post was first written September 2014, critical updates made May 2020
The Case For Prostate Cancer Active Surveillance
There is no question that with today’s medical knowledge and technology, the idea of keeping an eye on a slow growing, low stage and grade prostate cancer makes sense. The other option is to go straight into a treatment that cures the cancer, but for most men may have unpleasant side effects.
The idea of watchful waiting or active surveillance with a slow growing cancer is 1. The cancer may never need to be treated. Many men live a long, healthy and really unchanged life with prostate cancer. 2. If the cancer begins to change and spread, because it is being watched, treatment and cure can always be done while the cancer is still a low stage and grade.
#2 took a long time for life insurance underwriters to embrace. Their guidelines said that cured was the only insurable outcome and, while your doctor may have disagreed, the underwriters were the guys approving life insurance. Back when this post was first written one company broke that mold and decided that maybe the medical community was on to something. If I had to venture a guess, I suspect that an underwriter at company was diagnosed with low stage and grade prostate cancer and chose active surveillance. From that position he was able to impress upon the medical director and chief underwriter that active surveillance wasn’t a reckless ignoring of a potentially deadly disease, but a prudent and “active” option.
Active Surveillance and Life Insurance Back Then
10 years ago the idea of being approved for life insurance while on active surveillance for prostate cancer was, well, laughable. While the medical community accepted that active surveillance had results equal to or better than aggressive treatment, life insurance underwriters were stuck. They didn’t want to approve any cancer cases that weren’t cured.
I wrote back then about a client who was something of a poster child for the idea of life insurance underwriting, watchful waiting, and approval all being on the same poster. He had been declined by several companies, but the picture and the trend seemed clear and smooth so we dug out all of his past reports and shopped it. Not unexpectedly we only got one offer, but it was a reasonable offer and with all of the records already in hand it sailed through underwriting to approval and in force. That was 2014 and a “poster child” only got one offer.
In the case of the client above there were cancer cells in 30% of one of twelve biopsy cores. a relatively small finding leading to an assumption of early stage cancer. His PSA at the time of diagnosis was 6.0, the lab result that prompted the biopsy. Post biopsy it has been as high as 6.6 and as low as 3.5. There was no obvious abnormality of the prostate during the digital rectal exam.In the client’s quest to ensure watchful waiting was appropriate they also consider his free psa% which was 13% at the time of diagnosis, but over the 4 years had increased to 20%. He also did two PCA3 tests, both of which were less than 5. Over 30 is considered highly likely for prostate cancer and under 10 is considered unlikely. He also had two scans that didn’t show any definitive areas of cancer. To say the client looked at all of the evidence before making his decision to watch and wait is kind of an understatement, but what makes that decision so sensible is that he regularly has DRE’s and psa tests. He continues to get annual scans. If the situation in his prostate changes, he’s going to know it in plenty of time to take appropriate treatment action.
What a difference 6 years makes. I just got a case approved with the best of 6 companies who made offers. Six companies! The best rate class available for watchful waiting/active surveillance in 2014 was a standard table 2 (50% above a standard rate). Now we can get standard rates. Those are great rates. This has opened the door to improve on life insurance that men already have in force, in spite of being older, saving them money. I am optimistic that we will be able to find even better rates within a few years.
Bottom line. There never has been a huge opening for life insurance approval of watchful waiting, but it’s an open window for far more than ever even hear about it or consider it. Especially for us older guys, near or over 60, watchful waiting and approved life insurance can come together in the same sentence. If you have questions or would like to test the waters to see if you can get approved, call or email me directly. My name is Ed Hinerman. Let’s talk.