The histologic prevalence of pure anterior/ anterior- dominant PCa is between 10% and 38% [2–5]. Three studies with a cumulative sample size of over 4100 showed that about 35% of APCs originated from TZ, while almost half had PZ origin [5, 11, 14]. Interestingly, most of these APCs were found in the mid-gland (Fig. 25.3), followed by the apex, with the highest anatomical distribution of PCa being between the mid-gland and apex (0.5–1.3cm from the apex, where the prostatic glandular boundary tapers and meets the urethral sphincter) [5, 11, 14–17]. Clinical adoption of mpMRI increased the clinical diag­nosis of APCs over time. As the nodularity and density of the prostatic hyperplasia are heteroge­neous, the interpretation of TZ lesions has always been a challenge (Fig.25.4a). Several validations of PIRADS versions from 2012 (v.1) to 2019 (v2.1) showed that the detection of PZ tumors enhanced signicantly in each version, but this improvement was less pronounced for TZ can­cers [18]. Thus, TZ cancers remain an area with signicant inter-reader disagreement rates. Additionally, an examination of anterior partial prostatectomies indicated that tumor volumes in the anterior region of the prostate are frequently underestimated due to the challenges in MRI interpretation in the TZ and AFMS [19]. As men­tioned earlier, benign prostatic hyperplasia dislo­cates the APCs anteriorly (Fig. 25.1b). Interestingly, MRI often indicates higher false positive rates for EPE in APCs located in the transition zone, as opposed to anterior lesions in the peripheral zone [20].