229 PZ and 270 TZ lesions were included in this study. The proportion of overall PCa and clinically important PCa detection (Gleason score≥3+4) for each PI-RADS version 2.1 category was determined. The performance of PI-RADS version 2.1 in cancer detection was evaluated. The diagnostic accuracy of the overall(82.6%) and csPCa TZ lesions(83.0%) is higher than the accuracy of PZ lesions(80.4%, 77.7%). For the csPCa diagnosis, the AUCs of PI-RADS version 2.1 in TZ(0.84) was higher than in PZ(0.77) without significance(P=0.06). Higher PI-RADS version 2.1 scores were associated with increasing likelihood of the presence of clinically important PCa (P<0.01).