Benign Prostatic Hypertrophy (BPH)

    Benign prostatic hypertrophy (BPH) is an inevitable result of aging in men. An overgrowth of the prostate gland with either benign enlarged tissue or small nodules, the prevalence of this condition goes from about 20 percent in men 40 years old to almost 90 percent when they reach their 70s.

    BPH, while not cancer, can cause problems with both obtrusive symptoms for men as well as possibly even urinary blockage and chronic kidney disease in more extreme cases. It is a very common condition that is encountered while underwriting male lives.

    The most common symptoms of BPH are divided between obstructive and irritative complaints. Obstructive problems include hesitancy, decreased caliber and force of urinary stream, straining to urinate, and incomplete bladder emptying. Irritative symptoms include urgency, frequency and nocturia. Common television commercials describe the condition as a “going” problem, and indeed it is, with both frequency and urgency.

    A doctor can easily make the diagnosis on the basis of symptoms and a physical exam with rectal examination to feel the size of the prostate. Urinalysis and a PSA (prostate specific antigen) are done in the laboratory to look for other concomitant or more serious causes. Imaging (x-ray) and cystoscopy generally are reserved for those undergoing invasive therapy as a treatment.

    While there used to be only surgical treatments for the disease (with incontinence and loss of sexual function and erection as significant side effects) there are many different medical treatments now available as well.

    Medications called alpha-blockers and 5 alpha-reductase inhibitors minimize symptoms.

    Minimally invasive therapy such as laser treatment or needle ablation or even transurethral electro vaporization destroys excess prostate tissue with a far lesser degree of unacceptable side effects. The 5 alpha-reductase inhibitors help shrink the size of the gland.

    Problems with BPH during underwriting are usually two-fold.
    The first is when it must be differentiated from prostate cancer. Most insurance blood work contains a measurement of prostate specific antigen. As everyone doesn’t have a rectal exam done on application or a detailed physical exam, the PSA helps screen for hidden problems. While BPH, because the volume of prostate tissue is high, will usually result in an elevated PSA, prostate cancer causes elevations far higher.

    An elevated PSA result, coupled with a lowered “free” fraction of measurable PSA (done on the same sample) are suspicious for prostate cancer and will cause a trip back to the doctor and/or urologist for further testing, which can involve multiple biopsies of the gland. That line between what is BPH and what is a malignant process (cancer) has to be assessed before an insurance offer is given.

    Sometimes the prostate gland becomes so enlarged as to cause almost complete obstruction of urine from the urinary tract. In these cases, the urine refluxes back upward toward the kidneys and can cause eventual kidney failure. While the process is a “benign” one, the end result can be quite serious, and that, too, must be remedied before an insurance offer is made.

    One other problem that arises in BPH with high PSA levels involves the insured or his physician’s attitude toward a definitive treatment. BPH is not a cancerous process, but the obstructive part can cause eventual problems in other organs in the genitourinary tract. Likewise where PSA levels are high and the probability of cancer must be determined, some men feel that prostate cancer is slow growing enough that they will take their chances with “watchful waiting” to avoid any of the side effects of surgery that can affect both continence and sexual performance with their physician’s blessing.

    Treated or monitored BPH almost always is compatible with a best class issue, but avoidance of the diagnosis and eventual treatment often results in postponement or declination of the policy application.

    MD, FACE, FLMI, board certified internist and endocrinologist, is medical director for SBLI of Massachusetts. He has extensive brokerage and life insurance experience over 30 years with Pacific Life, MetLife Brokerage and Transamerica Occidental Life.

    Goldstone is board certified in insurance medicine and the inaugural recipient of the W. John Elder Award for Insurance Medicine Journalism Excellence. He was also honored as a fellow of the prestigious American College of Endocrinology and has written monthly for Broker World from 1991 to September, 2021.

    Goldstone can be reached by ­telephone at 949-943-2310. Emaill: drbobgoldstone@yahoo.com.