Prostate-specific antigen (PSA) testing in asymptomatic men can instigate an early diagnosis of prostate cancer, potentially avoiding higher risk disease and enabling the management to be more effective. While it remains the most commonly used test for prostate cancer screening or monitoring after a prostate cancer diagnosis or its treatment, its use as a screening test for prostate cancer is widely debated [1] due to its high sensitivity and a low specificity [2], its inability to distinguish between cancers and non-cancer conditions, and the known harms associated with overdiagnosis and over-treatment of screen detected cancers [3]. Increased rates of PSA testing are typically associated with increases in prostate cancer diagnoses and higher observed cause specific survival [4].

While population-based screening for prostate cancer is not endorsed internationally nor implemented as policy in any country in the world, during 2005–2009 52% of Australian men aged 40 years and over had at least one Medicare-funded PSA “screening” test [5]. Medicare reimburses four categories of PSA tests (66655, 66656, 66659 and 66660) and for the purposes of this paper we refer to item 66655 as de-facto “screening” tests (henceforth referred to as PSA screening tests), as it relates to tests undertaken on asymptomatic men. In 2016, the Prostate Cancer Foundation of Australia and Cancer Council Australia [6] released national evidence-based guidelines that did not recommend a population-based prostate screening program, and instead advised informed individual decision-making regarding PSA testing. The guidelines state that men aged 50–69 years who make an informed decision to have a PSA test be offered biennial PSA testing. These recommendations are generally consistent with similar USA [7], [8], [9] and Canadian recommendations [10].

In Australia, PSA screening rates have been consistently lower among men living in less accessible regional and remote areas of Australia versus the rest of the country [5], [11], and lower in socioeconomically disadvantaged populations[5], however these estimates relate to the period of highest PSA testing rates more than ten years ago. While modelled rates have decreased nationally since around 2007[5] it is not known whether these trends are consistent across geographical areas, and whether the geographical disparities reported previously[5], [12], [13] have persisted over time.

The aim of this study is to describe Medicare-funded PSA screening test patterns and trends by State and Territory, remoteness of residence and socio-economic status. This information may be used to guide policy makers about temporal changes in PSA testing and its implementation, and thus inform the development of recommendations or future revisions of the Australian PSA testing guidelines.