A real show stopper in the life insurance application process is when a PSA comes back high, or at least elevated compared to previous PSA’s. This has turned into something of a fussing point since, in most cases, life insurance underwriters will postpone an application until the reason for the PSA elevation is diagnosed. In their mind this almost always requires a biopsy because, while BPH or prostatitis could be to blame, they want to rule out cancer.
Well, the rest of the free world has been running straight away from using the PSA alone as a reason for a biopsy. The truth is that far too often the biopsy comes back negative which means an invasive procedure was done for no reason and on the other side, if there is cancer, a needle biopsy can, well, let the cat out of the bag. It can actually be responsible for allowing cancer cells to leave the prostate.
So comes a new test. Called the PHI, prostate health index, it actually combines the strong points of the PSA, free PSA and a never before used test called a -2 pro PSA. It is highly accurate in detecting just prostate cancer where the long used PSA test can be off by as much as 25% making small increases questionable. The PSA, prostate specific antigen, test will also increase when there is an inflammation or an infection in the prostate. Both of those conditions are easily treatable and are not indicative of prostate cancer.
So, how will life insurance underwriters view the PHI? I’ve already had a client tell me that they have an elevated PSA at 4.7 but their doctor has recommended no biopsy and wait until September when the PHI is available in the US. Of course until the test is available the underwriters will stay their course and demand proof of the absence of cancer, but my sense is that they stand ready to embrace something that can definitively rule out prostate cancer without a biopsy. We have thrown the question out to several companies and as this unfolds I believe we will see a long past due change in the reliance on the PSA.
I don’t know enough about the parameters of the test yet to know how it will plug into the watchful waiting approach to prostate cancer. My sense is that with the new, more sensitive results, watchful waiting will become even more prevalent. That will challenge those companies that already have underwriting guidelines for watchful waiting to rethink and possibly make it more acceptable as an approved treatment, and an approved life insurance impairment.
Bottom line. With PSA tests having as high as a 50% false positive rate, perhaps the PHI can bring some sanity to prostate cancer life insurance underwriting. If you have any questions, or have had prostate cancer and want to know how to get approved for affordable life insurance, call or email me directly. My name is Ed Hinerman. Let’s talk.