Prostate cancer: a review of common underwriting problems, Part 1

Part 1 of a two-part discussion of Prostate Cancer from an underwriting perspective, covers the epidemiology and screening for prostate cancer. Included is a "Primer on Screening Tests" that discusses problems with digital rectal exam (DRE) and prostate specific antigen (PSA) as screening tests. Approaches to enhancing the use of PSA for screening including age and race specific ranging, PSA density, PSA velocity, free PSA, and complexed PSA are discussed. Arguments for and against the use of PSA for prostate cancer are presented. The widespread use of PSA testing in the insurance setting is contrasted with cautious statements concerning general use of PSA in the clinical preventive care setting. In a future issue, Part 2 will cover staging and follow-up of treated prostate cancer.