I had mentioned in a post not too long ago about a new test that might negate the need for invasive biopsies when men have a high or elevating PSA. A recent Reuters article kind of hit the nail on the head when it comes to the reliability of the PSA as an indicator of whether or not a biopsy should be performed. “Using data from past cancer studies and a mathematical model, researchers from the Netherlands calculated that on average, annual screening using prostate-specific antigen (PSA) testing would add three healthy weeks to a man’s life.”
Now there’s a valid medical screening. You’ll pay more for regular screenings and unnecessary biopsies than it would cost to spend three weeks in the most expensive resort in the world. So along comes this urine test called a PCA3 that can tell if you have prostate cancer without a biopsy. I’ve never had a needle biopsy of the prostate but I can tell you that it is definitely on my short list of things that make me cringe just thinking about it. I’ve been told by those who have had them that I have it appropriately ranked. But pain and discomfort aside, the real deal is that needle biopsies are dangerous.
If that needle happens to find some cancer after being poked into your prostate, there is a chance that on the way out cancer cells can be left outside the prostate inadvertently. While this is rare, it is a real concern. Invasive, just like it sounds, carries more risk than non invasive. So how do you get from the non invasive elevated PSA to a non invasive conclusion that there is no prostate cancer? Especially from a life insurance underwriting standpoint? Underwriters since the first instance of prostate cancer in a caveman have depended on the PSA as an indicator of cancer, or at least the need for a biopsy. Even with the biopsy they are often squeamish about letting go of the PSA because, after all, you’re only getting a needle size core each time and if there isn’t much cancer it can be missed.
The PCA3 may or may not be what underwriters, doctors and men have been yearning for all these years. Does it get any easier than peeing in a cup to find out if the cancer genes are present? When the test was first announced as having been given approval (supposedly in the US this month) I queried several underwriters that were doubtful that it would change their underwriting in the near run, but admitted that as the test is more widespread and proven they might just jump on board.
Bottom line. I am currently shopping a case where a client has had an elevated PSA for several years, had a biopsy when it was first discovered that was negative, and just recently had a PCA3 test that was negative. I may not win the war with this case, but companies will know that the war has started. Just like with watchful waiting, there has to be a time when common sense comes through.