Prostatic lesions like Benign Prostatic hyperplasia (BPH), prostatitis, and adenocarcinoma account for significant mortality and morbidity in the geriatric male population. Prostate specific antigen (PSA) level has become the most popular screening method for the detection of different prostatic lesions. We aim to study the Histopathological spectrum of the lesions of the prostate and its correlation with PSA. A Cross-sectional study was done on 75 prostatic specimens. Relevant clinical data, PSA levels, and histopathological diagnosis were noted. The histopathological spectrum of different prostatic lesions was categorized into benign and malignant lesions. PSA correlation was done. Sensitivity and specificity were calculated at PSA cut-off levels of 4ng/ml, 10ng/ml, and 20ng/ml. 85.3% (n=64) of the lesions were benign while 14.7% (n=11) of the lesions were malignant. BPH with chronic prostatitis was the most common benign lesion accounting for 45.3% cases (n=34). All the malignancies were adenocarcinoma and were mostly of Gleason’s Grade 2. PSA showed maximum sensitivity i.e. 100% at level 4ng/ml but showed minimum specificity of 43.30% and specificity was seen increasing with increasing PSA cut off and was maximum at level 30ng/ml i.e.95.08%. The most frequently encountered lesion of the prostate is BPH with chronic prostatitis. PSA is an early and sensitive marker but has a limitation at a cut-off value of 4ng/ml; but it lacks specificity.