Friday 24 July 2015
Prostate cancer: are your insurance clients at risk?
Friday 24 July 2015
What insurance advisers need to know to advise their clients
Each year, prostate cancer takes the lives of more than 3,000 men in Australia.1
Prostate cancer is the most common cancer in Australian men (excluding non-melanoma skin cancer), accounting for 30 per cent of all new cancers in men in 2010.2
In 2020 an estimated 25,310 men are expected to be diagnosed with prostate cancer in Australia.3
If you're an insurance adviser, a number of your clients may be at risk of becoming one of these statistics. They may have inadequate knowledge about the risk factors of the disease. They may also have inadequate insurance cover against the inconvenience and the costs that inevitably follow a prostate cancer diagnosis.
What is prostate cancer?
The prostate gland is part of the male reproductive system. It sits below the bladder and in front of the rectum.
Cancer occurs when normal prostate cells mutate and form clumps of abnormal cells, which then kill off any surrounding normal tissue due to the pressure of the cancerous tumour on these cells.
The first major risk factor for prostate cancer is age – the older you get, the more risk you have of developing prostate cancer. Prostate cancer is rare in males under the age of 50 years, with the majority of diagnoses being made in men over the age of 60 years.
If a father or brother has had prostate cancer there is an increased risk, as is the presence of prostate intraepithelial (PIN) cells, which are precancerous. PIN is similar to carcinoma-in-situ of the breast or ovary etc.
A higher incidence of prostate cancer occurs in African-American men, with a decreased incidence in Asian men. A diet high in animal fats has also recently been linked to prostate cancer.
Several other links to prostate cancer have been suggested, but are yet to be proven. They include benign prostatic hypertrophy (BPH), obesity, smoking, viral infection of the prostate, lack of exercise and vasectomy.
There are often no symptoms associated with prostate cancer, although warning bells should sound if a man experiences decreased or staggered urine flow, frequent urination (particularly at night), pain or burning on urination, decreased erections, blood in the urine or semen, or pain in the lower back, hips or upper thighs.
If any of these symptoms are experienced, it's best to consult with a doctor, who will initially perform a blood test that measures the level of prostate-specific antigen (PSA). If the PSA level is greater than 10ng/ml, then further testing is required to exclude prostate cancer.
The doctor might also perform a free PSA test, which measures the amount of unbound PA in the blood. Low free PSA levels are more indicative of prostate cancer.
In addition, a digital rectal examination can assess both the size and consistency of the prostate gland. Possible further investigations include transrectal ultrasound, cystoscopy, imaging (eg MRI) or even transrectal biopsy.
Once prostate cancer has been diagnosed, the cancer would need to be staged (ie assessed to determine size and spread).
There are two main types of staging used for prostate cancer – TNM and Gleason.
TNM staging determines the size of the tumour (T), whether it has spread to surrounding lymph nodes (N) and whether there are metastases (M). The spectrum ranges from Tx (where the cancer cells can’t be evaluated) to T4N2M4 (where the tumour is large and has spread throughout the body).
The Gleason classification score assesses the histological pattern of the cancer cells in the prostate and is based on five grading patterns, generating a total histological score from 2-10 made up of a primary (predominant pattern in the area) and secondary (most common) pattern. The overall Gleason score correlates with the tumour extent and is a good prognostic indicator of the cancer.
Staging is important, because it can indicate the prognosis for the patient and an estimated survival time. Generally, 99 per cent of men who are diagnosed with prostate cancer survive at least 5 years. 91 per cent of men have a TNM staging of ≤ T3 and have a 5 year survival rate of almost 60 per cent. This 5 year survival period drops to about 32 per cent if the staging is T4. The rate of death from prostate cancer is decreasing year by year due to better treatment.
Treatment depends on the stage of the prostate cancer and can range from regular surveillance of the cancer to removal with adjuvant therapy. The initial and most common form of treatment is surgery – once the prostate gland is removed there is a high cure rate.
Other types of treatment include radiotherapy (to the prostate gland and surrounding areas) and hormone therapy be delivered either locally (directly to the prostate gland) or systemically (to the whole body).
From an insurance perspective, men over the age of 45 should have adequate health cover as well as trauma or critical illness cover. Full payments are made for most trauma or critical illness claims when the prostate cancer is greater than a T1a level (ie more than 5% of cancer cells are found in a prostate biopsy specimen). Under this level, there would not be intensive treatment and the financial need for a critical illness benefit to pay out is less, resulting in many policies only providing a partial payment.
From an underwriting point of view, a client who has previously been diagnosed with prostate cancer may be able to get cover with either an exclusion or loading, but this would depend on the stage of the prostate cancer, what type of therapy was done (ie was the cancer removed), how many years is it since the diagnosis and what benefits are being applied for.
Advising your clients
Prostate cancer screening is as easy as taking a blood test – any male older than 50 years should do this on a regular basis. You can recommend this to your male clients who are this age group. In fact, it might be argued that it’s your professional duty to do so.
You can also check that their insurance cover is appropriate in relation to their individual risk factors. In this way you can contribute to saving lives as well as lifestyles.