Background/Aims: Prostate cancer is fourth most common male cancer, recent data showed an increased incidence among Sudanese males and it is becoming a major medical problems and gained increased attention from Sudanese urologists. Objective: To detect patients with prostate cancer, in prostatectomy specimens, with normal preoperative PSA levels. To try to suggest a base line level of PSA above which prostatectomy should not be performed unless having a histological tissue diagnosis. Materials and methods: This is descriptive, prospective cross sectional, hospital based study, conducted at Soba University Hospital, Omdurman Military Hospital, IbnSina specialized Hospital in the period from September 2012 to August 2013All patients above 40 years of age undergoing prostectomy with normal PSA levels in the above mentioned hospitals were enrolled in this study, their surgical specimens was sent for histology. Results: The PSA level was below 4ng/ml in all cases, with a mean of 1.85ng/dl (total), and 0.36ng/dl free PSA. The histology of the prostatectomy specimens showed adenocarcinoma in 14 Pts (13.1%) and BPH in 93 pts (86.7%).Conclusion: There was a detection rate of (13.1%) among patients with PSA below ng/ml, with high grade Gleason scores. Suspicious DRE in low PSA patients enhances the cancer detection rate.