Utilization of prostate-specific membrane antigen positron emission tomography in Australia following government subsidization: Trends in primary staging and biochemical recurrence

Prostate-specific membrane antigen positron emission tomography (PSMA-PET) offers superior accuracy over conventional imaging for the primary staging of intermediate-high risk prostate cancer (PCa) and in the biochemical recurrence (BCR) setting. In 2022, PSMA-PET became eligible for subsidy under Australia’s Medicare Benefits Schedule (MBS), reducing financial constraints and improving access for patients. This study presents the first national analysis of PSMA-PET uptake in Australia since MBS subsidization. This was a retrospective population-based analysis of PSMA-PET studies performed between July 2022 and March 2025 using MBS codes 61563 (primary staging) and 61564 (BCR). Data were stratified by year, state, age group, and setting and standardised per 100,000 men using population data. 90,412 PSMA-PET imaging studies were performed during the study period, with 60,995 for primary staging and 29,417 for BCR. There was a significant increase for primary staging with an average rise of 1.56 studies per 100,000 men (p = 0.04; 95% CI 0.07 – 2.99). NSW recorded rapid and sustained growth, while Queensland maintained the highest per capita usage. Uptake for BCR rose modestly with similar geographic heterogeneity observed (p = 0.28; 95% CI = 0.37 – 1.23). Our findings demonstrate rapid and widespread uptake of PSMA-PET in Australia following MBS subsidization, especially in primary staging. Regional disparities in access persist, particularly in Western Australia and the Northern Territory. These findings highlight the impact of national health policy on imaging utilization to improve diagnostic staging, and detection of recurrence in PCa, and emphasise the need to address geographic inequities in advancing diagnostic care.