I was just talking to a client today on the first anniversary of his life insurance policy going in force through me. He came to me in the 4th year of prostate cancer watchful waiting, 57 years old at the time. He was something of a poster child for the idea of life insurance underwriting, watchful waiting, and approval 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.
So what does it take to get approved for life insurance when you have prostate cancer that shows on a biopsy and don’t intend to treat it unless it shows signs of causing a problem? Most life insurance companies say that any untreated prostate cancer is a problem, but when that urban myth is hanging out there that says all of us guys will eventually have prostate cancer but most of us will never know and won’t die or even get sick from it, watchful waiting doesn’t seem absurd medically. Watchful waiting, put in context, makes perfect sense. A recommendation for watchful waiting is generally for a lower grade, Gleason 3+3=6, with a strong presumption of low stage. Since the most accurate staging comes from a biopsy of the entire prostate surgically removed, staging with needle core biopsies is basically done by comparing how much cancer is found out of the total sample collection.
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.
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.