When my term life insurance policy expired in 2013 and I had to get a new one, I thought my widow-maker heart attack in 2005 might be a sticking point. Instead, eight insurers turned me down because they said I had “untreated cancer.”
They were referring to the tiny amount of prostate cancer found three years earlier.
My urologist/urological oncologist at the University of Chicago saw no need for surgery or radiation. Instead, he recommended active surveillance, close monitoring with prostate-specific antigen (PSA) blood tests, biopsies, and later MRIs of my cancer, which he swore I would die with and not from. The plan has worked well for me.
But I quickly learned that insurance underwriters with cash on the table saw my situation differently than my doctor did.
I previously had paid $184 a month for $600,000 in term coverage. After the rejections and continued negotiations, the only policy I could land was $100,000 in universal life — a conversion of my original plan with no new medical exam required, same $184 premium. Losing most of my coverage made the financial consequences of a cancer diagnosis painfully clear.
I wasn’t looking for a preferred rate reserved for people with spotless medical histories. Mine isn’t spotless.
What bothered me most was the phrase “untreated cancer.” I hadn’t ignored medical advice — I had followed it. My second-opinion urologist had told me in 2010 to hold off on treatment. He called my Gleason 6 or Grade Group 1 cancer “lame.” I wasn’t insulted.
Pathologist Donald Gleason developed his scoring system in the 1960s at the Minneapolis Veterans Administration to grade prostate cancer by how cells are arranged under a microscope. Today, pathologists assign two pattern scores, each ranging from 3 to 5, and add them together for a Gleason score of 6 to 10. Gleason 6 (3+3), also called Grade Group 1, sits at the bottom of the scale. Doctors recommend active surveillance for men like me with this low-risk cancer. Former President Joe Biden’s cancer falls near the other end: His office announced in May 2025 that he had Gleason 9, or Grade Group 5 — the highest grade group — and that the cancer had spread to his bones.
Recently, I decided to explore whether a man in my situation, unchanged for nearly 16 years, would fare any better today. I asked two insurance brokers — both Gleason 6 patients themselves — to walk through a hypothetical case: a 64‑year‑old man with a new Gleason 6 diagnosis and a past heart attack. In effect, I sent a younger version of myself out shopping for a term policy. Let’s call him Young Howard.
Their assessments weren’t formal underwriting decisions, but they revealed the same obstacles I faced years ago. One broker found some insurers might postpone a decision about Young Howard for three to five years. They’d want to see stable PSA results and no upgrading. Young Howard could follow his urologist’s advice to the letter and still wait years to find out whether he’s insurable. And, of course, he’d be three to five years older by then and have higher rates.
The heart attack added its own penalty under the insurance industry’s “table rating” reflecting a mortality risk when an applicant’s health or lifestyle doesn’t qualify for “standard rates” but the insurer still wants to offer coverage. Each table adds 25% to the standard premium.
One broker estimated the heart attack could land Young Howard in Table 6, roughly 150% above standard rates. A $1,000 annual premium could jump to $2,500.
In this scenario, the heart attack now drives the pricing, while the prostate cancer delays the application.
The brokers’ ballpark estimates for Young Howard ran into thousands of dollars a year.
One broker echoed my frustration: “Insurance companies haven’t caught up to what [the experts] know: Prostate cancer rarely escapes the prostate if the patient has stable PSA and a Gleason 6.”
Insurers, of course, assess the chance an applicant might die during the policy term — from any cause. My heart attack in 2005 fits squarely into that calculation. And a Gleason 6 biopsy can’t guarantee that more aggressive disease won’t appear later. Follow‑up matters.
But I reject the idea that a man who keeps every surveillance appointment has “untreated cancer.” Clarifying how insurers interpret “untreated” versus monitored cases could help us better understand their decisions. The medical record should tell insurers far more than those two words.
Underwriters should be more open about their decisions and respond to the information the doctors share.
Brokers can’t forecast that every man on active surveillance will be denied or charged more. But they strongly suggest that the challenges I faced haven’t disappeared since 2013.
For patients, the insurance issue adds to their worries, making them feel understood and less alone in facing these challenges.
Would surgery or radiation improve Young Howard’s chances of getting affordable coverage? I don’t have the answer. But it’s worth asking insurers — especially if a patient is considering treatment partly to resolve an insurance concern.
I still have unanswered questions. Among them: How do insurers weigh years of stable findings? Do they follow specific policies or guidelines for men on active surveillance? When a man has both prostate cancer and heart disease, how much does each condition influence the decision?
Clear explanations from insurers would foster trust and hope, helping patients and doctors feel more confident in their decisions.
In 2013, I needed life insurance and ended up with far less than I wanted. I followed my doctors’ advice. I’m still waiting for a clear explanation of why that made me so hard to insure.
Howard Wolinsky is a Chicago-based medical journalist and editor of The Active Surveillor, a Substack newsletter that covers active surveillance news. He brought the insurance problem to the attention of the American Urological Association’s Insurance Roudtable earlier this year.
STAT’s coverage of health challenges facing men and boys is supported by Rise Together, a donor advised fund sponsored and administered by National Philanthropic Trust and established by Richard Reeves, founding president of the American Institute for Boys and Men; and by the Boston Foundation. Our financial supporters are not involved in any decisions about our journalism.
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