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Background: Prostate-specific antigen (PSA) is a widely used biochemical marker for the early detection and monitoring of patients with prostatic cancer. PSA level show ever may vary with patient age, race and may be elevated in conditions such as benign prostatic hyperplasia (BPH) and prostatitis. Any diagnostic or surgical maneuver that alters the normal prostate architecture can lead to diffusion of PSA into the stroma and thus into the vasculature. Objectives: The present study was done to study the efficacy of PSA to categorize men with prostate pathology into benign, premalignant, and malignant lesions. Materials and Methods: Two years prospective study from September 2012 to August 2014 in the Department of Pathology, MVJ Medical College and Research Hospital, rural Bengaluru on 62 cases of prostate biopsies in men with prostatism. Clinical digital rectal examination (DRE) findings and PSA levels of each patient were noted from the case records. The levels of PSA in the various pathological lesions encountered were analyzed. Results: 62 prostate biopsies were received over a 2-year period, 41 cases satisfied the inclusion criteria were analyzed. DRE findings showed majority of the benign lesions (82.7%) to be firm. PSA levels below 4 ng/mL efficiently could segregate the benign lesions but with values beyond 4 ng/mL the picture becomes murkier with contributions from inflammation and BPH raising PSA to levels where malignancy would be suspected. Conclusion: In our study, PSA levels appear to be elevated in both benign and malignant lesions, therefore, the usefulness of PSA alone as an early detector of prostatic cancer by itself is questionable. In elderly patients with PSA levels above 4 ng/mL and with abnormal DRE, a prostatic biopsy is advisable to rule out cancer.