Background
The diagnosis of clinically significant prostate cancer is often challenging. The 4K® score test may assist in evaluating the risk of significant malignancy and avoid biopsies in non-significant disease. The COVID-19 pandemic caused a remarkable disruption in managing patients with suspected prostate cancer.
The aim of this study is to evaluate the effect of the COVID-19 pandemic on 4K ®score test results by comparing tests performed in Israel between April and July 2020 to a control group of the same period in 2019.
We assumed that focusing on coping with the pandemic and its implications will decrease prostate MRI tests and prostate biopsies and as a result, there will an increase in the 4K score blood tests as well as a change in the pre-biopsies prostate risk stratification.
Methods - A retrospective cohort study comparing the characteristics of the study group to the control group was done using diagnostic multi-variables statistical analysis.
Results - A 37% reduction in the number of 4K ® score tests performed (450 versus 721) was noted. The reduction was seen mainly among men older than 65 years. A significantly higher percentage of patients with 4K ® scores indicating a high risk of clinically significant prostate cancers (>20%) was noted among men younger than 65 years compared to the control group.
Conclusions - The COVID-19 pandemic had an influence on the number of tests performed, especially in the elderly. Delay or lack of supportive imaging during the pandemic may be the reason for the higher 4K ® scores among younger patients.
The reduction in the number of 4K tests on the one hand and the fact that non-urgent diagnostic procedures and exams (eg prostate MRI exams, prostate biopsies etc.) were less available during the COVID-19 era could have caused a delay in prostate cancer diagnosis and treatment.
Key words - 4K® score test, COVID-19, prostate cancer, PSA.