Background: Prostate gland disease causes significant morbidity in elderly males. Our objective of the study was to evaluate the histopathological spectrum of prostatic lesions in correlation with prostate specific antigen and compare the prostate specific antigen with histological grade of prostatic adenocarcinoma. Methods:The present retrospective study was carried in the department of pathology, Narayana Medical College & Hospital, Nellore, and Andhra Pradesh, India from January 2015 to December 2015. 119 Prostatic biopsy specimens were analyzed histopathologically for diagnosis of types of prostatic lesion and correlated with serum PSA level. Prostatic adenocarcinomas were graded according to Gleason histological grading. Gleason's grading of tumors was correlated with serum PSA levels Result: Out of 119 patients, 95 cases had benign prostatic hyperplasia, 17 cases had prostatic adenocarcinoma, 7 cases had prostatitis. In our study, the maximum number of BPH cases (51.58%) showed PSA levels < 4ng/ml. Most of prostatic adenocarcinoma (82.35%) displayed PSA levels >10ng/ml. 5 cases (71.43%) of prostatitis showed PSA levels of 4 to 10ng/ml. Maximum cases of grade 2 and grade 3 prostatic adenocarcinoma had PSA range of 20-49.99 ng/ml. Conclusion:Benign prostatic hyperplasia is the most commonly diagnosed prostatic lesions. Investigation like serum PSA level detection can aid in the diagnosis, but accurate diagnosis of non-neoplastic and neoplastic lesions of prostate can be made by histopathological study of prostate biopsy.There is a positive relation was seen between higher levels of PSA and Gleason histopathological grade.