So far this year I’ve really been able to get a handle on how life insurance underwriters really feel about prostate cancer watchful waiting or active surveillance. Watchful waiting is when a doctor, usually a urologist with a background in treatment of prostate cancer, decides that a case of prostate cancer is a low enough stage T1 and a low enough grade, Gleason 6 or under, that taking a step back and seeing how, or if, it progresses is more prudent and safe than actively treating the cancer. So how do underwriters feel about this approach to prostate cancer? Well, they just aren’t sure is about as honest an answer as I can give. So here are 3 things that seem to be most important in underwriting active surveillance life insurance.
- The stage. This is one area where I think they are being a little stuffy in their view. Stage 1 can be a T1a, T1b or T1c. The difference between the three is how the samples were obtained. Underwriters give favor to a and b because the cancer was found, usually during a TURP procedure, and there was no other factor driving the impetus to do a biopsy. So underwriters like these findings because they were more random and there was a little more meat involved. A T1c is found in a needle biopsy generally triggered by an elevated PSA. It is a smaller sample but certainly enough to know if it is a stage 1 or not.
- Age. Underwriters and reinsurance companies would optimally like to see a client over age 65, even better a diagnosis after age 65. I have been able to get a few companies to go as low as age 59. Unfortunately this stance by life insurance companies is in opposition to modern treatment of prostate cancer. The idea with active surveillance or watchful waiting is to put off unnecessary invasive treatment such as radiation or radical prostatectomy. Both of these methods of treatment have incurable side effects which, while not life threatening, are life style changing. Putting that off when the cancer is not life threatening and can be treated if that ever changes is the direction of modern prostate cancer treatment. Watchful waiting in urology is a treatment method.
- Most prostate cancer is found after a high PSA reading. Even though the same reading can indicate an enlarged prostate (BPH) or an infection of the prostate (prostatitis), doctors want to rule cancer in or out so they perform a needle biopsy. This is usually twelve core samples taken by hollow needles. Underwriters want to see no more than 10% total involvement of all 12 cores. That is to say that if one core has 5% involvement and another has 10%, they see that as 15% total involvement and it is too much. Again, I see this as a little conservative when you are talking about the prostate, walnut sized, and 15% of the inside of 12 needles. But, they are the underwriters that have to approve it and they make the final decision.
Bottom line. Life insurance is available for watchful waiting or active surveillance….in some cases. Unfortunately not as many as I would like to see given the fact that active surveillance is just a holding pattern that can change to invasive treatment which is almost always completely successful with low stage cancer. If you have questions or would like to see if you might qualify, make sure you have a copy of your biopsy, then call or email me directly. My name is Ed Hinerman. Let’s talk.