Purpose: Prostate Specific Membrane Antigen (PSMA) positron emission tomography (PET) is a new standard of care in recurrent prostate cancer. Currently, in Ontario, Canada, access to PSMA PET is available through a prospective multicentre registry. While socioeconomic status (SES) disparities exist, less is known in the context of PSMA PET. The objective of the study was to determine if SES was associated with PSMA PET access, PET positivity, management change, radiation utilization and survival of prostate cancer patients in a universal health care system. Materials and Methods: Patients enrolled in the Ontario PSMA PET Registry for Recurrent Prostate Cancer (PREP) between December 2018-September 2022 were included. The Ontario Marginalization Index (material resources, racialized and newcomer, age and labour force, and household and dwellings) was used. Outcomes included access, PET positivity, management change, radiation utilization and survival. Cox proportional hazards models and logistic regression models examined the association between marginalization and outcomes. Additionally, marginalization in the PSMA PET cohort was compared with a diagnosis cohort of prostate cancer diagnosed/treated between April 2006-March 2022 as well as a survivorship cohort of patients who received primary treatment and were alive in the year of 2022 using provincial administrative databases. Results: There were 4034 patients identified in the PSMA PET cohort. Patients at higher material marginalization quintiles were under-represented in the PSMA PET Registry Database (Q1 27.81%, Q2 22.58%, Q3 19.33%, Q4 17.29%, Q5 13.00%). Similar under-representation was noted in the diagnosis (N=123,128, Q1 23.7%, Q2 22.5%, Q3 20.0%, Q4 17.7%, Q5 16.0%) and survival (N=56,753, Q1 23.7%, Q2 21.9%, Q3 20.1%, Q4 18.2%, Q5 16.0%) cohorts. Within the PSMA cohort, there was no difference in pre-imaging disease parameters, PET positivity, disease burden, management change or radiation utilization across the material resources categorizations. Marginalization dimensions were not significantly correlated with PET positivity (p=0.60), change in management (p=0.99) or radiation utilization (p=0.11). After adjusting for patient factors, increased material marginalization was positively correlated with increased all-cause mortality. Conclusions: Distribution of marginalization quintiles among PSMA PET was similar to the distribution among prostate cancer diagnosis and survivorship cohorts. As material marginalization increased, there was a gradient of increasing all-cause mortality, but PSMA PET related parameters and outcomes were not affected. In a universal healthcare system, we found no association of marginalization to PET positivity, management change or radiation utilization among those receiving PSMA PET. Identifying disparities will help improve equitable access of healthcare resources.