Introduction
Prostate cancer is the most common malignancy among men [1]. For
many years the evaluation and diagnosis of this disease was based on PSA
blood test [2] and digital rectal examination (DRE). In the last
decade, new tests are available and may assist physicians distinguish
between patients who harbor a high-risk significant prostate cancer and
those with low-risk prostate cancer and thus rationally select patients
who need prostate biopsies. One of the diagnostic options today is the
4K® score test which is a blood test sampling the
level of three serological markers besides the PSA: free PSA, intact PSA
and human kallikrein-related peptidase 2 (hK2) [3]. Different
studies reported a greater efficiency in diagnosing aggressive prostate
cancer by using the 4K® score test comparing the
standard PSA level, allowing avoiding biopsies among patients assuming
to have less aggressive disease [4,5].
Patients with 4K ® score of 7.5% or less are considered to have a
low-risk for diagnosis of a prostate cancer of Gleason score of 7 or
higher if a biopsy was performed. Also, these patients have less than a
1% risk of having metastasis within 20 years [6]. In contrast,
patients with a 4K® score above 33% are 33% more likely to have a
Gleason score ≥7 prostate cancer if a biopsy was performed [4, 7].
COVID-19 has a global effect with substantial mortality as well as
indirect effect on evaluating other diseases [8], reducing human
resources, reducing budgets, directing clinics to treat only COVID-19
patients, and reducing primary evaluating facilities with local or
regional instructions to reduce visits in hospitals and outpatient
clinics with other diseases. This reality may cause delayed diagnosis of
other diseases, including malignancies. The diagnosis rates of different
malignancies reduced significantly in USA comparing the pre-COVID 19
era, a finding which its implications may be noticeable for years to
come [9]. A study using a mathematical model to evaluate the
expected influence of a delayed diagnosis on the mortality rate,
predicted an incline in preventable mortality rate the next years among
patients with different malignancies [10].
In Israel, during the COVID era, few quarantine periods were declared in
which people were instructed not to leave their homes unless for
prespecified reasons such as essential medical treatment. In addition to
that, the Israeli ministry of health instructed hospitals and clinics to
reduce elective procedures.