How Prostate Cancer Impacts Underwriting

Jeff Root Jeff Root
Posted in Risk

One of the things that constantly surprises us as humans is how something so small can have such a large impact on a person’s life. For those of us who work in the life insurance industry, we come face-to-face with scenarios every day that may seem small to the rest of the population, but have huge impacts on life insurance premiums.

One of the high-risk diseases that gives us – and many of our clients – pause is prostate cancer. 1 in 7 men will be diagnosed with prostate cancer during their lifetime, and all start with one small gland; specifically, the prostate gland.

The prostate gland is located between the bladder and the penis. It surrounds the urethra and is responsible for producing the fluid that makes up semen. The prostate gland is also an important component in ejaculation, as the muscles located in this gland press semen into the urethra and help expel it outward.

In a healthy individual, this gland is small; roughly the size of a walnut, and weighs about an ounce.

The prostate gland consists of three zones:

  1. The transition zone: the smallest part of the gland and the closest to the urethra;
  2. The central zone: surrounds the transition zone and comprises a quarter of the prostate’s mass;
  3. The peripheral zone: the main part, making up about 75%of the prostate. Most cancer is found in this zone.

How Prostate Cancer Is Formed

In healthy cells, the process of division, growth and cell death all occur This keeps your cells replenishing and functioning properly in one of two phases: mitosis or interphase.

Interphase refers to the process of cell growth and DNA replication. It is in this phase that cells spend the majority of their time. Our bodies enact a series of checkpoints to ensure that cells function properly.

When your cells aren’t functioning properly, they self-destruct in a process known as apoptosis. This prevents these defective cells from continuing to grow and to rob healthy cells of the nutrients necessary to function.

Mitosis is the division cells undergo in order to produce new cells. This happens at various rate throughout your body, depending on the type of cell. A prime example is the rapid pace at which hair follicles go through mitosis compared to brain cells.

Cancer; however, occurs when one small cell sets off a chain reaction and, instead of undergoing the normal cell cycle, cells are allowed to divide and grow unchecked. Due to their uncontrollable division, these calls cannot function properly and, thus, cancer is formed.

In the prostate, the catalyst for this formation is a hormone known as androgen. Testosterone is an example of an androgen hormone, and it causes the prostate to grow during puberty when testosterone levels are incredibly high, and again in old age, when your body make attempt to even out low testosterone levels.

This growth of the prostate can be attributed to benign prostatic hypertrophy, infection, medicine or any number of things, and is not always cancerous. However, when prostate growth becomes cancerous, abnormal cells can attach themselves to the blood vessels or other bodily tissues.

Applying For Life Insurance With Prostate Cancer

One thing to keep in mind about prostate cancer is that, with early detection and breakthroughs in treatment options and methods of testing for the cancer, prostate cancer may not impact your lifestyle as much as you think. This is because this type of cancer grows so slowly in men that, often, no treatment other than active surveillance is recommended.

Despite this, prostate cancer will impact your life insurance premiums. Here are a few things your agent and underwriter will need to know when underwriting your policy:

Your PSA levels

PSA stands for “prostate specific antigen” and is measure through a blood test. This test measures how much protein is emitted by the prostate gland; the higher the amount, greater the indicator of the presence of cancer, although this is not always the case. Your insurer will want to know the date of your last screening as well as the levels your PSA test reveals.

Typically, higher PSA levels in the blood increase the likeliness of the presence of cancer, although this is not always the case. A number of causes, including benign prostatic hypertrophy and prostatitis, raise PSA levels, so be sure to indicate the presence of these conditions as well.

These levels are measured in nanograms, per each milliliter of blood. Normal PSA levels look similar to this:

  • Ages 40-49: up to 2.5 ng.ml
  • Ages 50-59: up to 3.5 ng/ml
  • Ages 60-69: up to 4.5 ng/ml
  • Ages 70 +: up to 6.5 ng/ml

The way insurers utilize these levels is changing.

PSA levels used to be a primary indicator of the presence of cancer; however, the PSA test is notoriously unreliable. This means that underwriters will require more information than just your PSA levels when assessing you for coverage.

Instead of just looking at your levels, insurers will want to know the following: the PSA density, or the concentration of PSA in the blood; and its velocity – the rate at which these levels have increased. The velosity and density are examined, along with the levels of PSA unbound to a protein. Low levels of the latter, known as free/unbound PSA, could indicate the presence of cancer.

Your Gleason Score

The Gleason Score is a system for grading prostate cancer. This score is comprised of two numbers: a primary score assessing the area where the cancer is most prominent; and a secondary score, indicating how far the cancer has advanced. When added together, these two scores can provide an accurate picture of your cancer and help determine the best options for treatment.

Underwriters will look at your Gleason Score, along with your cancer’s stage and grade in order to provide an accurate assessment of your risk.

 

The Stage and Grade of Your Cancer

Staging is the process used to determine how far the cancer has progressed. For prostate cancer, this process is known as TNM Staging.

TNM Staging is a method used to refer to the size and the reach of the primary cancer tumor (T), its spread to the lymph nodes (N) or it’s metastasis (M).

Grade is the term used to refer to how aggressive the cancer is; if the cancer cells are “well differentiated” it means that they are similar to non-cancerous cells, and “if they are noted as “poorly differentiated,” it means that they differ drastically from non cancerous cells.

Most prostate cancer is detected early, during the lower grades I and II. This means that the cells are less aggressive and are typically found in one or many areas of the prostate only. For applicants, this may earn you a “standard” rating, depending on your Gleason Score (typically 6 or less for these stages) and the type of treatment chosen. You may also have a flat extra added to your premium for a certain time period after treatment.

Grades III and IV are more aggressive cancers, and typically have Gleason Scores of 6 or higher. These cancers have either spread beyond the prostate or to the lymph nodes. Your treatment methods and prognosis will determine your rating, but you may have to endure a waiting period after treatment in order to get insurance.

The Treatment Options You Choose

Prostate cancer is an interesting risk for underwriters to assess because, often, no treatment is required other than active surveillance. This means regular biopsies and digital rectal exams (DRE), along with frequent PSA monitoring to assess the growth of the cancer.

Should you require treatment other than active surveillance, there are a number of treatments you could choose, and all come with their unique risk factors.

Radiation is a common form of treatment for prostate cancers, as is surgical removal or chemotherapy.

Because no two prostate cancer diagnoses are alike, your underwriter will look at your treatment options as one facet of your risk. Equally as important as the option you choose is the date of your last treatment and the date of your last follow-up. These two indicators can provide an accurate assessment of the current state of the cancer and will be able to help you on your way toward better ratings.

Give Us A Call Today

Prostate cancer is, perhaps, one of the most difficult cancers to underwrite because so many factors must be taken into consideration.

You should present the facts of your case to your agent so that he or she can help you find the best and most affordable coverage to suit your unique situation.

 

Any questions?  Feel free to email me at krystn@noel-insurance.com, fill out the quote form on the side or call 877-817-2583

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