OBJECTIVES: To determine the extent of social inequality in uptake of prostate cancer screening in Ireland and compare inequalities across groups for whom the cost effectiveness of screening is thought to vary.  METHODS: A series of decomposition analyses of inequalities in uptake of prostate cancer screening were undertaken using data collected as part of a large population based survey in the Republic of Ireland (SLAN 2007). Separate analyses were conducted for individuals differentiated by age on the basis of reported differences in the cost effectiveness of screening. A range of explanatory variables were used to explore the role of non-need factors in inequalities including education and possession of private medical insurance.  RESULTS: Overall uptake of prostate screening in men aged 40 years and over in the preceding 12 months was 23.81%.  Uptake was highest among those in the age group where the cost effectiveness of screening was deemed to be highest (based on the findings of the European Randomised Study of Prostate Cancer (ERSPC) trial).  The lowest socioeconomic inequality was also observed among this age group. The decomposition of the concentration indices showed that possession of private insurance was the largest determinant of inequality among those 55-69 (36%) and remained a significant determinant among those aged 40-54 (26%) and aged 70 and over (17%).  CONCLUSIONS: The decision to engage with screening is one likely to be taken in conjunction with a healthcare professional and reflect an assessment of the expected costs and benefits of screening to the individual. Where evidence as to the merits of screening is ambiguous and financial incentives to screen are evident patterns of uptake may emerge that does not represent an appropriate use of resources and warrant greater scrutiny.  KEY WORDS:  Prostate Cancer  PSA Test  Screening  Incidence  Diagnosis  Concentration Indices  Decomposition Analysis