The Transperineal Transition: Medicare‐Funded Prostate Biopsy in Australia, 2021–2025

ABSTRACT Transperineal prostate biopsy is increasingly preferred over the transrectal route because of its lower infectious risk and antibiotic stewardship advantages. This study examined contemporary national, geographic and age‐specific trends in Medicare‐funded prostate biopsy in Australia. A retrospective population‐level analysis of publicly available Medicare Benefits Schedule (MBS) claims was performed. Annual service counts for transperineal biopsy (item 37219) and transrectal biopsy (37216) were extracted for 2021–2025 and stratified by jurisdiction and age group. Outcomes included annual service volumes, biopsy‐route proportions, compound annual growth rates and age‐specific rates per 100,000 men. Temporal trends were assessed using Poisson regression. MBS claims do not capture all Australian prostate biopsies, particularly procedures delivered in public hospitals. Between 2021 and 2025, 133,663 Medicare‐funded prostate biopsy services were recorded, comprising 128,879 transperineal and 4784 transrectal procedures. Total annual MBS‐claimed biopsy activity increased from 23,549 to 30,551 services (+ 29.7%). Transperineal services increased from 22,361 to 29,635 (+ 32% incidence rate ratio [IRR] 1.068 per year, 95% confidence interval [CI] 1.064–1.072), while transrectal services decreased from 1188 to 916 (−22.9%; IRR 0.932, 95% CI 0.913–0.951). The transperineal‐to‐transrectal service ratio increased from 18.8:1 in 2021 to 32.4:1 in 2025. In 2025, New South Wales and Queensland accounted for 99.1% of all transrectal services nationally. Age‐specific transperineal biopsy rates increased across all age groups, with the greatest relative rise among men aged 45–54 years. Australian Medicare‐funded services, prostate biopsy activity shifted further towards the transperineal route between 2021 and 2025. Residual transrectal claims became highly concentrated in New South Wales and Queensland. Because MBS data incompletely capture public‐hospital procedures, geographic differences should be interpreted as differences in Medicare‐funded service utilisation rather than definitive differences in whole‐of‐system clinical practice. Further linkage with hospital, cancer registry and provider‐level data is required to explain these patterns.