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Introduction: Socioeconomic determinants of prostate-specific antigen (PSA) testing and prevalence of undiagnosed prostate cancer (PCa) in the Polish population are poorly understood. The aim of this study was to identify factors associated with PSA testing in elderly Polish men, and estimate the size of the population at risk of PCa related to PSA non-testing. Material and methods: We analyzed questionnaire-derived data concerning PSA testing, obtained in 2567 elderly and 332 younger (age: 55-59) participants of the population-based PolSenior study. Additionally, PSA was measured in 2414 subjects. Results: The PSA had previously been tested in 41.2% of elderly and in 24.8% of younger participants. Non-smoking status (OR = 2.06, p < 0.001), higher personal income (OR = 1.56, p < 0.001), better education (OR = 1.49, p = 0.001), previous white-collar work (OR = 1.37, p = 0.005), alcohol abstinence (OR = 1.28, p = 0.02), married status (OR = 1.24, p = 0.04), dependence in Instrumental Activities of Daily Living (IADL) but not in Activities of Daily Living (ADL) (OR = 0.65, p < 0.001), and dependence in ADL (OR = 0.55, p < 0.001) were independent predictors of previous PSA testing in elderly participants. There were 31 elderly previously treated for PCa (calculated standardized prevalence: 935 per 100,000 elderly population). The PSA levels > 4 ng/ml were found in 12.8% of 65-74-year-old and 4.5% of 55–59-year-old previously non-tested participants. We calculated the standardized prevalence rate of undiagnosed PCa as approximately 1370 and 2352 cases per 100,000 population aged 55-59 and 65-74 years, respectively. Conclusions: In Poland, 58.8% of elderly men have never had PSA tested. These were less likely to be functionally independent, married, better educated, non-smokers or to have previous office employment or higher than average personal income. Our data suggest substantial underdiagnosis of prostate cancer among Polish men.