A Rose by Any Other Name

An IPCSG Newsletter Feature — companion to "What Men Need to Know Before Saying 'Yes' to a Genetic Test"

Companion piece: This article picks up where the previous IPCSG feature on germline genetic testing left off. That article addressed the question of insurance timing for untested family members contemplating a genetic test before any diagnosis. This one addresses the question many already-diagnosed members ask: now that I have the diagnosis on my chart, what does that actually mean for any new insurance I might want to buy?

"What's in a name? That which we call a rose
By any other name would smell as sweet." — Romeo and Juliet, Act II, Scene II

Juliet was wrong, at least about prostate cancer. The name very much matters. A pathologist's report that uses the word "cancer" to describe a microscopic finding of pure-pattern-3 prostate adenocarcinoma — a condition that may never affect the man's health — re-prices every future life-insurance, long-term-care, and disability application he ever makes. Renamed something like "Grade Group 1 prostatic neoplasia" or "acinar neoplasm of the prostate," the same finding would carry no such consequence. The rose smells very different depending on what we call it.

This article is a practical guide for men who already carry the diagnosis. It explains how the U.S. insurance industry actually treats a prostate-cancer history at intake, what outcomes you can realistically expect by scenario, why long-term-care and disability underwriting are tougher than life-insurance underwriting, and what the active campaign to retire the cancer label from Grade Group 1 disease has to do with all of this.

BLUF — Bottom Line Up Front

A prostate-cancer diagnosis is a "cancer" diagnosis to insurers regardless of grade group. ICD-10 code C61 — malignant neoplasm of prostate — is the same code applied to Gleason 6 / Grade Group 1 on active surveillance and to Gleason 9 metastatic disease. Underwriters do not subdivide it at intake.
Life insurance after diagnosis is achievable far more often than feared. For low-risk disease (Gleason 6, stable PSA, T1–T2a, on AS or successfully treated), the typical outcome is a postpone period of 3–12 months for treated cases and 12–36 months for AS, followed by rated premiums in the Table 2–4 range (50–100% over standard), often returning to standard within 3–5 years. Outright denial is uncommon for this profile.
Long-term care and disability insurance are materially tougher. Postpone periods are longer, declines are more common, and a manifest cancer diagnosis carries more weight than for life insurance — even for low-risk disease.
Existing policies in force are not affected. A prostate-cancer diagnosis does not alter, raise, or cancel coverage you already hold. The cancer-history question only arises on new applications.
Multi-carrier shopping through an impaired-risk broker is essential. Underwriting guidelines vary dramatically by carrier. Prudential, Lincoln Financial, Protective Life, Banner, John Hancock, and Pacific Life have all earned reputations as relatively friendly to prostate-cancer cases, but the leader varies by year and by applicant profile.
The financial case for renaming Grade Group 1 has been under-discussed. The clinical case (avoiding overtreatment, anxiety, and unnecessary biopsy cascades) has been argued for half a decade. The financial case — that millions of men carry a lifetime insurance penalty for a finding that may never affect their health — deserves a louder voice in the conversation.

The Empirical Reality: How Common Is "Cancer"?

Histologic prostate cancer — meaning cells that meet the pathological definition of malignancy under the microscope — is extraordinarily common in older men. Autopsy studies on men who died of unrelated causes have consistently shown prostate adenocarcinoma in roughly 30% of men in their fifties and over 80% of men in their eighties. The vast majority is Gleason 6 / Grade Group 1 (GG1). In modern clinical practice, biopsies in men with elevated PSA frequently turn up at least one GG1 core; informal observation among IPCSG members suggests this is closer to a rule than an exception.

The clinical implication is well understood: most of these tumors will never become symptomatic, never metastasize, never require treatment, and never shorten the man's life. Long-term active-surveillance cohorts followed for fifteen-plus years (Klotz et al., 2015; Tosoian et al., 2020) report metastasis-free and prostate-cancer-specific-mortality rates approaching the general age-matched male population. Pure pattern-3 disease essentially never spreads to lymph nodes (Ross et al., 2012). For most of these men, the cancer is more biographical fact than medical event.

The insurance implication, however, is permanent. Once "Gleason 3+3=6, adenocarcinoma" appears on a pathology report and is coded into the medical record, the cancer-history pathway is triggered for life.

The Renaming Debate

Since 2022, a substantial group of urologic oncologists and pathologists — led by Scott Eggener (University of Chicago), Matthew Cooperberg (UCSF), Andrew Vickers (Memorial Sloan Kettering), Gladell Paner (University of Chicago), and Laurence Klotz (Toronto) — has argued for retiring the "cancer" label from GG1. Their 2022 Journal of Clinical Oncology paper, "Low-grade prostate cancer: time to stop calling it cancer," makes the case on three pillars:

GG1 lacks the clinical hallmarks of cancer. No metastasis to lymph nodes in pure pattern-3 disease (Ross 2012); long-term outcomes in active-surveillance cohorts approach age-matched general population mortality (Klotz 2015, Tosoian 2020).
The cancer label drives substantial overtreatment. The 2023 AUA Quality (AQUA) registry reported approximately 40% of men diagnosed with low-risk prostate cancer in 2021 still received immediate definitive treatment (surgery or radiation) despite consensus that active surveillance is the preferred initial management. These treatments produce no survival benefit in low-risk disease but real rates of incontinence, erectile dysfunction, and bowel symptoms.
The cancer label causes psychological harm. Hudnall and colleagues showed in a 2021 Cancer paper that nomenclature alone — describing identical pathology as "cancer" versus a non-cancer term — measurably alters patient anxiety and treatment choices.

The opposing view, articulated by William Catalona and others and reflected in the 2022 World Health Organization classification (Netto et al., 2023, European Urology), is that GG1 still meets the histologic definition of carcinoma — notably the absence of a basal cell layer; that some GG1 tumors carry aggressive genomic profiles indistinguishable from GG2; that biopsy sampling error means apparent GG1 may coexist with higher-grade disease elsewhere in the gland; and that the cancer label, properly used, motivates appropriate surveillance. The WHO retained the cancer designation in its 2022 update.

The campaign has continued. Eggener and Cooperberg presented and debated the question at AUA 2023 and again at ASCO GU 2024 (Eggener's keynote: "Public Health Would Dramatically Improve if Gleason 6 / Grade Group 1 Weren't Called Cancer"). The 2025 GU Cast podcast revisited the question. The clinical pieces of the argument are now well-rehearsed in the urology literature. What is missing — and what the IPCSG community is uniquely positioned to articulate — is the financial dimension.

The ICD-10 Reality: One Code Fits All

Every U.S. medical record that documents any biopsy-proven prostate cancer, whatever its grade, is coded under ICD-10 C61 — malignant neoplasm of prostate. The code is identical for:

Gleason 6 / GG1 on active surveillance with stable PSA and no progression on imaging.
Gleason 7 / GG2 or GG3 treated with radical prostatectomy or radiation.
Gleason 8–10 / GG4 or GG5 high-risk disease.
Metastatic castration-sensitive or castration-resistant disease at any grade.

Insurance underwriters work from the medical record. The underwriting questionnaire on a new individual life-insurance application typically asks: "Have you ever been diagnosed with, treated for, or advised to seek treatment for any form of cancer?" A man on active surveillance for GG1 with a PSA that has not budged in five years must answer "yes" to that question, just as a man with a Gleason 9 prostatectomy must. The intake then differentiates by grade, stage, PSA, treatment, and time — but the gateway answer is the same. The ICD code travels with you for the rest of your life.

This is the core externality the renaming debate identifies but rarely names directly: the insurance industry is a very large downstream consumer of pathology nomenclature, and pathology nomenclature drives lifetime financial consequences for tens of millions of men.

How Life Insurance Underwriters Actually Evaluate Prostate Cancer

Once the cancer-history pathway is triggered, the underwriter assesses six factors in roughly this order of weight:

Gleason score / Grade Group at diagnosis. The single most important variable. Gleason 6 / GG1 is the most favorable; Gleason 7 (3+4 vs. 4+3 — the order matters) is intermediate; Gleason 8–10 is the most challenging. Underwriters have access to the original biopsy pathology report and the surgical pathology report (if a prostatectomy was performed); the operative grade may differ from the biopsy grade.
Clinical or pathological stage. T1–T2a localized disease is favorable; T3 extracapsular extension or seminal-vesicle invasion is unfavorable; node-positive (N1) or metastatic (M1) disease shifts the case into impaired-risk or guaranteed-issue territory.
PSA at diagnosis and most recent PSA. Diagnostic PSA under 10 is favorable; under 20 is acceptable; over 20 raises red flags. Post-treatment PSA should be undetectable (under 0.1 after prostatectomy; nadir-plus-2 trend after radiation). Rising PSA is the single most likely trigger for postpone or decline.
Treatment received and treatment outcomes. Radical prostatectomy with negative margins and undetectable PSA is the most favorable picture, because the prostate is gone and the disease is presumed eliminated. Radiation with stable post-treatment PSA is next. Active surveillance with stable PSA is roughly equivalent to treated low-risk disease after the postpone period. Hormone therapy (ADT) is consistently rated as unfavorable, signaling more advanced disease — even when it was given for non-metastatic indications.
Time since diagnosis or treatment completion. Most carriers want at least 12 months of stability. Three years cancer-free is the industry inflection point at which standard or near-standard rates become realistic for low-risk disease. Five years is better for higher grades.
Age at diagnosis. Counterintuitively, older diagnosis is often more favorable. A diagnosis at 70 is treated more leniently than a diagnosis at 50 — partly because prostate cancer is so common in older men that the actuarial impact is smaller, and partly because the underlying mortality assumptions are already age-adjusted.

Typical Outcomes by Scenario

The following outcomes reflect aggregated industry experience as reported by impaired-risk brokers. Real cases vary; this is a calibration, not a guarantee.

Scenario	Typical Postpone	Typical Rating After Postpone	Realistic Best-Case
Gleason 6 / GG1 on Active Surveillance, stable PSA < 10, age < 65	3 years of documented PSA stability	Table 2–4 (50–100% over standard)	Standard at 3 years stability with the right carrier; some cases earlier with Prudential or Lincoln
Gleason 6 / GG1 on Active Surveillance, age 65+	Typically 12 months of stability	Table 2–4, often less	Standard at 12–18 months with carriers like Protective
Gleason 6 treated by radical prostatectomy, undetectable PSA	3–12 months from surgery	Standard or Standard-Plus often available	Non-Smoker Plus / Standard-Plus with Prudential, Lincoln; Standard with most carriers within 12 months
Gleason 6 treated by radiation, stable post-treatment PSA	12 months from treatment completion	Standard available	Standard with Lincoln, Prudential, Protective at 12+ months
Gleason 7 (3+4) treated by RP or radiation, stable PSA	1–2 years from treatment	Table 2–6 (50–150% over standard)	Standard achievable at 3–5 years with the right carrier
Gleason 7 (4+3) — pattern-4 dominant — treated, stable PSA	2–3 years from treatment	Table 4–8	Substandard rates; some carriers may decline first 3 years
Gleason 8–10, treated, no recurrence	3–5 years from treatment	Table 6–12 (150–300% over standard)	Substandard markets only (American General, Transamerica); declines common in early years
On hormone therapy (ADT) at time of application	Generally postpone until treatment completion plus 1–3 years	Substandard, high tables	Difficult; guaranteed-issue coverage may be the practical option
Metastatic / mCRPC	Generally not eligible for fully underwritten new individual life insurance	—	Guaranteed-issue policies with limited face amounts; group life (often guaranteed-issue) if employed

Two patterns deserve specific note for the IPCSG audience.

Active surveillance is not penalized as harshly as patients fear. The Mayo Clinic Connect community discussion captured the consensus among impaired-risk brokers: Gleason 6 is "not even considered actionable in most cases" by experienced cancer-underwriting carriers, particularly at older ages. After three years of stable PSA on AS — which is the routine clinical follow-up anyway — Standard or near-Standard rates are realistic. The industry has, in this respect, partially absorbed the science even where the WHO and the ICD coding have not.

Counterintuitively, AS sometimes prices better than treatment in the long run. A treated case carries treatment-related morbidity in the file (incontinence rates, ED, occasional bowel toxicity from radiation, surgical complications). An AS case with stable PSA carries none of that. Past the 3-year stability mark, several brokers report that experienced cancer-underwriting carriers price AS cases as well as or better than equivalent-grade treated cases.

Long-Term Care Insurance: The Tougher Conversation

Long-term-care insurance underwriting differs sharply from life-insurance underwriting in ways that disadvantage cancer survivors. Cancer is the fourth most common reason for admission into a long-term care facility, and LTC insurers price that risk explicitly. The underwriting model is also different in kind: rather than focusing on mortality (life insurance), LTC underwriters focus on probability of needing assistance with activities of daily living for an extended period — a different actuarial question that weights cognitive, functional, and chronic-disease risks heavily.

For prostate-cancer survivors, the practical implications:

Postpone periods are typically longer. Most LTC carriers want 12–24 months of stability for low-risk disease and 3–5 years for higher grades, often longer than the equivalent life-insurance postpone.
Some carriers will approve cancer history with as little as 6 months of stability. A minority of A+ rated LTC underwriters have published guidelines accepting recent cancer history; these are the carriers an experienced broker will steer you toward.
Recurrent disease often triggers automatic decline. A first recurrence — biochemical or radiographic — that was successfully managed may still be insurable with some carriers; multiple recurrences typically are not.
Approval rates decline steeply with age. A 2016 Health Affairs analysis of LTC underwriting found the steepest age-related approval drop occurred at age 60 and above. Cancer history was associated with at least a 10-percentage-point decline in approval probability, comparable to back pain or psychiatric illness.

The practical message: LTC insurance is materially harder to obtain after a cancer diagnosis than life insurance. For IPCSG members who do not yet hold LTC coverage and are considering it, the timing principle is even more important than for life insurance — the window before any cancer-history coding appears in the record is far easier to underwrite. For those already past that window, multi-carrier shopping with an LTC-specialist broker is essential, and hybrid life/LTC products (which use life-insurance underwriting for the LTC rider) may be more accessible than standalone LTC.

Disability Income Insurance

Disability insurance — both short-term and long-term — is the third leg of the underwriting picture, and it sits closer to LTC than to life insurance in toughness. Disability underwriters focus on probability of work disruption, which prostate cancer affects through:

Treatment recovery. Surgical recovery, radiation fatigue, ADT side effects, and chemotherapy each have predictable disability profiles.
Recurrence risk and the workup it requires. Repeat biopsies, advanced imaging, and oncology visits all consume work hours.
Long-tail metastatic-disease risk. A Gleason 8 case in a 50-year-old presents 15+ years of potential disability claim exposure to the underwriter.

Outcomes typically include long postpone periods (often 2–5 years post-treatment for low-risk disease, longer for higher grades), exclusion riders that carve prostate-cancer-related disability out of coverage, and outright declines on more advanced cases. Group disability through an employer is often guaranteed-issue (no individual underwriting) and is, for many men, the most practical way to maintain meaningful disability coverage after diagnosis.

Existing Policies Are Unaffected

This is the most important point in the article and the one most frequently misunderstood. If you held life, LTC, or disability insurance at the time of your prostate-cancer diagnosis, that coverage is not affected. The insurer cannot retroactively raise your premium, cancel your policy, or carve out a cancer exclusion based on a diagnosis that occurred after the policy was issued. The contestability period (typically two years from policy issue) protects the insurer against material misrepresentation in the application — not against subsequent honest medical events.

The underwriting question only arises on new applications: a new policy, a request to increase coverage on an existing policy, or — in the case of convertible term policies — a conversion to permanent coverage that triggers fresh underwriting. (Most well-designed convertible term policies preserve the original health classification at conversion, but read the contract carefully; some require fresh underwriting.) For IPCSG members reviewing their financial planning, the practical point is to inventory what you already hold and recognize that the cancer-history question is a forward-looking concern, not a retroactive threat.

Multi-Carrier Shopping and the Specialty Markets

Underwriting guidelines for prostate cancer vary so widely between carriers that one company's automatic decline is another's standard rate. This is not anecdote — it is the consistent finding of every impaired-risk broker writing in this space. Carriers reach different conclusions about the same pathology report because their actuarial models, reinsurance arrangements, and target market segments differ.

The carriers most often named as friendly to prostate-cancer cases by experienced impaired-risk brokers, as of late 2025 / early 2026:

Prudential — frequently approves Gleason 6 prostatectomy cases as soon as 3 months post-surgery; consistently competitive at older ages.
Lincoln Financial — aggressive on Gleason 7 cases; often the leader for intermediate-risk disease.
Protective Life — particularly competitive for applicants 70+ with Stage 1 prostate-cancer history; has approved Standard rates in published broker examples.
Banner Life, John Hancock, Pacific Life, Mutual of Omaha, Symetra, Principal Financial — all competitive in specific niches; the leader rotates by year and by case.
American General, Transamerica — substandard / impaired-risk specialists; often the right answer when the standard market declines.

The practical recommendation is unambiguous: do not apply with one carrier and accept the first answer. Work with a broker who maintains relationships with at least a dozen carriers writing prostate-cancer cases, who can do a "quick quote" survey to multiple medical directors before formal application, and who has access to your full pathology report (biopsy and surgical, if applicable) and complete PSA history. The difference between Standard and Table 4 on a $500,000 20-year term policy for a 60-year-old is in the thousands of dollars per year — well worth the two or three weeks of broker shopping.

The Financial Case for Renaming Grade Group 1

The clinical case for retiring the cancer label from GG1 has been argued thoroughly in the urology literature for the better part of a decade — overdiagnosis, overtreatment, treatment-related morbidity, patient anxiety. Each of these is well-documented and forms a compelling case on its own.

What has been remarkably under-discussed is the parallel financial case. Consider the population the renaming would affect. Roughly 30% of American men in their fifties and 80% of men in their eighties carry histologic prostate cancer at autopsy; far fewer than that are ever biopsied, but the cohort that is biopsied skews heavily toward men with elevated PSAs, men whose biopsies frequently turn up at least one GG1 core. If we assume even modest screening uptake going forward, the cohort of American men carrying an ICD-10 C61 in their record because of an indolent GG1 finding is in the millions and growing each year.

Each of those men carries:

A permanent "yes" answer to the cancer-history question on every future life, LTC, and disability application.
Postpone periods on new individual coverage, even after years of stable disease.
Rated premiums that often persist for 3–5 years even when standard rates eventually become available.
Materially harder access to LTC and disability coverage, in many cases for life.
A cumulative financial cost that, across a population of millions, is in the billions of dollars in higher premiums and forgone coverage.

If GG1 were renamed — to "acinar neoplasm of prostate," "Grade Group 1 prostatic neoplasia," or some other non-cancer term that the pathology and urology communities can agree on — the ICD-10 coding would follow within a revision cycle. Insurance underwriting would, eventually, follow the coding. The financial penalty would diminish or disappear for the very large group of men whose disease will never threaten their health. The financial penalty would remain, properly, for men whose disease is genuinely cancer in the clinical and biological sense.

This is the argument the broader prostate-cancer advocacy community — including the IPCSG, ZERO Prostate Cancer, PCRI, the Prostate Cancer Foundation, and the dozens of regional support groups — might consider raising more loudly. The clinical case has been made by the urologists. The financial case is a patient-advocacy case, and patient advocates are best positioned to make it.

Practical Guidance for IPCSG Members

Inventory existing coverage first. Before any conversation about new coverage, write down what life, LTC, and disability insurance you already hold. Existing coverage is not affected by your diagnosis. The cancer-history question only matters for new applications or coverage increases.
Gather your pathology and PSA history. A complete biopsy pathology report (with grade, percentage of cores positive, and percentage of each core involved), the surgical pathology report if you had a prostatectomy, and a complete PSA history (every reading from diagnosis forward) are the three documents that drive every underwriting decision. Have them in hand before contacting a broker.
Use an impaired-risk specialist broker, not a generalist. Brokers who write prostate-cancer cases regularly know which medical directors at which carriers are friendly to which profiles. A generalist broker who shops your case to a single carrier may produce a decline that an impaired-risk broker can convert to Standard at a different carrier.
Time your application thoughtfully. If you are within the typical postpone window (12 months for treated radiation, 3–6 months for prostatectomy, 3 years for AS under 65), waiting until the window closes will materially improve your offer. If you are several years past the window with stable PSA, consider whether re-shopping every 3–5 years could move you from a rated table to Standard.
Don't accept the first decline. A decline by one carrier is one data point, not a verdict. Multi-carrier shopping converts many declines into offers.
Consider hybrid life/LTC products if standalone LTC is unavailable. Hybrid policies use life-insurance underwriting (which is friendlier to cancer history) and provide LTC benefits as a rider. They are more accessible than standalone LTC for cancer survivors, though the cost structure is different.
Don't overlook group coverage. Group life and group disability through an employer are often guaranteed-issue and bypass individual underwriting entirely. If you are still working, this may be the most cost-effective way to maintain coverage after diagnosis.

Patient Q&A

Q: I'm on active surveillance for Gleason 6 with a PSA that hasn't changed in four years. Will I be denied life insurance?
A: Almost certainly not. Your profile is one of the most insurable cancer-history profiles. With four years of stable PSA documentation, you should be well past the typical 3-year postpone for under-65 AS cases, and Standard or near-Standard rates are realistic with experienced carriers (Prudential, Lincoln, Protective have all approved similar profiles). Work with an impaired-risk broker and shop at least 5–8 carriers.

Q: I had a radical prostatectomy two years ago for Gleason 7 (3+4) with negative margins and an undetectable PSA. What can I expect?
A: You're in a favorable position. Most carriers will offer at this point; Table 2–4 ratings are realistic, and Standard becomes likely at the 3-year mark if PSA remains undetectable. Lincoln Financial has been particularly aggressive on Gleason 7 cases. A negative-margin pathology report and confirmed undetectable PSA are the two most powerful documents in your file.

Q: My existing life insurance company is going to find out I have prostate cancer at my next physical. Will they raise my rates or cancel?
A: No. Your existing policy was underwritten based on your health at the time of issue. Subsequent honest medical events do not affect the policy as long as you continue paying premiums. The insurer cannot raise your rates, impose a cancer exclusion, or cancel based on a diagnosis after issue. You also have no obligation to proactively notify the carrier about a new diagnosis on an existing policy.

Q: I'm on hormone therapy for biochemical recurrence after prostatectomy. Can I get any new life insurance?
A: Fully underwritten new individual life insurance is generally not available while on active ADT, particularly within the first year or two. Guaranteed-issue policies (typically lower face amounts, $25,000–$50,000, with no medical questions) remain available, as do group life policies through an employer. Once ADT is completed and PSA stabilizes, conventional underwriting becomes possible again, typically with substantial postpone periods and ratings.

Q: Should I tell my urologist that I'm worried about insurance implications?
A: Yes — particularly if you are weighing decisions like whether to escalate from AS to treatment, or whether your initial pathology report should be reviewed by a second pathologist. Insurance considerations should not override medical advice, but they are part of the full cost-benefit picture and a good urologist will engage with them honestly. Some urologists will obtain a second-opinion pathology read at a high-volume center (Johns Hopkins, MSKCC, UCSF, Cleveland Clinic) when there is question about whether GG1 might actually be GG2 — a re-read that occasionally downgrades disease and can affect your insurance picture in addition to your treatment.

Q: Does it help my insurance picture if my urologist documents that GG1 is "indolent" or "low-risk" rather than calling it cancer?
A: At the underwriting stage, only marginally. The ICD-10 code drives the intake, and the code is C61 regardless of how the visit note is worded. Some impaired-risk brokers can use specialist letters at the medical-director level to argue for better treatment, particularly when the case sits on the boundary between two rating tables. But a urologist's clinical language does not change the coding pathway. The renaming campaign aims at the deeper level — changing the pathology and ICD coding so that the underwriter intake itself differs.

Q: I'm in Florida. Does HB 1189 help me?
A: Florida's HB 1189 (in force since July 2020) bars insurers from using genetic test results in life, LTC, and disability underwriting. It does not bar insurers from considering a manifest cancer diagnosis from a biopsy pathology report — the diagnosis itself is fair game even in Florida. So HB 1189 helps Florida residents who have had genetic testing but no diagnosis; it does not change the picture for men who have been diagnosed via biopsy.

The Bottom Line

For the man already diagnosed with prostate cancer, the insurance picture is more workable than the initial fear suggests. Life insurance after diagnosis is achievable for the vast majority of low- and intermediate-risk cases, often at Standard or near-Standard rates within 3–5 years of treatment or stable AS. Long-term care and disability insurance are tougher, particularly post-diagnosis, and are the strongest argument for the timing principle covered in our companion article — locking in coverage before diagnosis is qualitatively easier than after.

The deeper point is the one Juliet got wrong. The name does matter. A pathology report's choice of word — "carcinoma" versus "neoplasia," "cancer" versus "Grade Group 1 finding" — has financial consequences that follow a man for the rest of his life. The clinical case for renaming Grade Group 1 has been carefully argued by Eggener, Cooperberg, and colleagues; the financial case is largely waiting to be made by the patients themselves and the organizations that advocate for them. For the millions of men who carry a lifetime insurance penalty for an indolent finding that may never affect their health, that case deserves a louder voice.

Sources and Further Reading

Eggener SE, Berlin A, Vickers AJ, Paner GP, Wolinsky H, Cooperberg MR. Low-grade prostate cancer: time to stop calling it cancer. Journal of Clinical Oncology 2022;40(27):3110–3114. doi:10.1200/JCO.22.00123.
Eggener SE. Removing the Cancer Label From Gleason 6 (Grade Group 1) Would Improve Public Health. AUANews, 6 December 2023. https://www.auanews.net/issues/articles/2023/december-2023/prostate-cancer-removing-the-cancer-label-from-gleason-6-(grade-group-1)-would-improve-public-health
Eggener SE. Public Health Would Dramatically Improve if Gleason 6 (Grade Group 1) Weren't Called Cancer. Presentation at the 2024 ASCO Genitourinary Cancers Symposium, San Francisco, 25–27 January 2024.
Paner GP, Zhou M, Simko JP, Eggener SE, van der Kwast T. Renaming grade group 1 prostate "cancer" from a pathology perspective: a call for multidisciplinary discussion. Advances in Anatomic Pathology 2023. doi:10.1097/PAP.0000000000000400.
Netto GJ, Amin MB, Compérat EM, et al. Prostate adenocarcinoma grade group 1: rationale for retaining a cancer label in the 2022 World Health Organization classification. European Urology 2023;83(4):301–303. doi:10.1016/j.eururo.2022.12.005.
Tosoian JJ, Mamawala M, Epstein JI, et al. Active surveillance of grade group 1 prostate cancer: long-term outcomes from a large prospective cohort. European Urology 2020;77(6):675–682. doi:10.1016/j.eururo.2019.12.017.
Klotz L, Vesprini D, Sethukavalan P, et al. Long-term follow-up of a large active surveillance cohort of patients with prostate cancer. Journal of Clinical Oncology 2015;33(3):272–277. doi:10.1200/JCO.2014.55.1192.
Cooperberg MR, Meeks W, Fang R, Gaylis FD, Catalona WJ, Makarov DV. Active surveillance for low-risk prostate cancer: time trends and variation in the AUA Quality (AQUA) Registry. Journal of Urology 2023. (40% of low-risk patients in 2021 still received immediate definitive treatment.)
Hudnall MT, Desai AS, Tsai KP, et al. It's all in the name: does nomenclature for indolent prostate cancer impact management and anxiety? Cancer 2021;127(18):3354–3360. doi:10.1002/cncr.33621.
Ross HM, Kryvenko ON, Cowan JE, Simko JP, Wheeler TM, Epstein JI. Do adenocarcinomas of the prostate with Gleason score (GS) ≤6 have the potential to metastasize to lymph nodes? American Journal of Surgical Pathology 2012;36(9):1346–1352. doi:10.1097/PAS.0b013e3182556dcd.
Jahn JL, Giovannucci EL, Stampfer MJ. The high prevalence of undiagnosed prostate cancer at autopsy: implications for epidemiology and treatment of prostate cancer in the Prostate-specific Antigen-era. International Journal of Cancer 2015;137(12):2795–2802. doi:10.1002/ijc.29408.
Sperling D. Is Gleason 6 Really Cancer? Sperling Prostate Center, updated September 2025. Reviews the 2025 University of Chicago single-center analysis of 418 GG1 patients on active surveillance with pre-biopsy mpMRI. https://sperlingprostatecenter.com/is-gleason-6-really-cancer/
GU Cast podcast. Renaming Gleason 6 prostate cancer | The campaign continues!!! September 2025. Featuring Scott Eggener and Matthew Cooperberg with hosts Renu Eapen and Declan Murphy.
RiskQuoter. Best Life Insurance for Prostate Cancer Survivors. Industry guide describing typical underwriting outcomes by grade, stage, and treatment, with carrier-specific guidance. https://www.riskquoter.com/high-risk/prostate-cancer-life-insurance/
CPS Advantage. Life Insurance Underwriting Strategies for Prostate Cancer. https://www.cpsadvantage.com/life-insurance-underwriting-strategies-for-prostate-cancer/
Bruckel K. Life Insurance Underwriting Strategies for Applicants with Prostate Cancer. LinkedIn Pulse industry article. (Notes that some insurers offer Standard rates approximately one year after treatment for Gleason 6 cases over age 50.)
Insurance By Heroes. Prostate Cancer Life Insurance Rates in 2026. March 2026. (Industry summary covering AS underwriting at Table 2–4.) https://insurancebyheroes.com/health-conditions/prostate-cancer-rates/
JRC Insurance Group. Prostate Cancer Life Insurance. January 2025. (Industry guide noting post-prostatectomy PSA threshold of 0.02 typical for decline.) https://www.jrcinsurancegroup.com/prostate-cancer-life-insurance/
Long Term Care Insurance Partner. Can a Cancer Survivor Get Long Term Care Insurance? (Industry guidance describing variability in LTC underwriting for cancer history; some A+ carriers approving with as little as 6 months of stability.) https://www.longtermcareinsurancepartner.com/blog/can-a-cancer-survivor-get-long-term-care-insurance
Cornell B, Konetzka RT, Coe NB, Werner RM. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers. Health Affairs 2016;35(8):1494–1503. doi:10.1377/hlthaff.2015.1133. https://pmc.ncbi.nlm.nih.gov/articles/PMC5127198/
EMG Brokerage. Case Study: How to Get Life Insurance After Prostate Cancer. Discusses underwriting strategy for recurrent disease and PSA-fluctuation cases. https://emgbrokerage.com/case-study-prostate-cancer/
Florida HB 1189, "Genetic Information for Insurance Purposes," codified at Fla. Stat. §§ 626.9706, 626.9707, 627.4301; effective 1 July 2020. (Bars insurers from using genetic test results in life, LTC, and disability underwriting; does not bar consideration of manifest disease.) https://www.flsenate.gov/Session/Bill/2020/1189/Analyses/h1189c.COM.PDF
U.S. Centers for Medicare and Medicaid Services. ICD-10-CM Code C61 — Malignant neoplasm of prostate. ICD-10 code reference. (Single code applies to all grades and stages of biopsy-proven prostate adenocarcinoma.)
Shakespeare W. The Tragedy of Romeo and Juliet, Act II, Scene II. ("What's in a name? That which we call a rose / By any other name would smell as sweet.")

Search This Blog

Informed Prostate Cancer Patient Support

Insurance Considerations for Men Diagnosed with Prostate Cancer