The study was aimed to determine the diagnostic yield and outcome of transrectal ultrasound-guided prostate biopsy (TRUSPB) in a cohort of Sri Lankan men. A prospective study was conducted among 333 (median age: 70 years, range:48-88) men from a single urology unit. All patients underwent TRUSPB for persistently elevated serum prostate specific antigen (PSA)≥4.00 ng/mL or suspicious rectal examination. The prostate cancer (PCa) detection rate was 57.7%. The PCa detection rate for PSA levels of 4.00 to <10, 10.00 to <20, 20.00 to <40, 40.00 to <100 and ≥100.00 ng/mL were 15/43(34.9%), 23/88(26.1%), 41/72(56.9%), 51/63(81.0%) and 60/62(96.8%) respectively. Ten patients required further biopsies for rising PSA despite a first benign biopsy and three had PCa. Mild complications were identified in 6.9%(n=23). The high PCa detection rate probably reflects the difference in our policy to perform biopsies only when serum PSA level is persistently elevated. TRUSPB appears to have a satisfactory yield with acceptable level of complications in the Sri Lankan resource limited setting.