Purpose We examined the association of prostate specific antigen testing with prostate cancer incidence, tumor differentiation and mortality according to socioeconomic status. Materials and Methods Participants were 96,484 men between 40 and 99 years old without preexisting prostate cancer who were registered with a general practitioner in the Tayside region of Scotland, United Kingdom, between January 1, 2003 and December 31, 2008. We performed a retrospective cohort analysis using anonymized health data, including biochemistry data on prostate specific antigen tests, Scottish Index of Multiple Deprivation, cancer registry data set and General Register Office for Scotland death records. Main outcome measures were prostate specific antigen testing, prostate cancer incidence and death. Results Men in the most affluent Scottish Index of Multiple Deprivation quintile had a greater chance of undergoing a prostate specific antigen test (OR 1.48, 95% CI 1.40–1.57, p