Traditionally, anaerobic digestion has been applied to mixed sludge, combining primary sludge (PS) with secondary sludge. However, recent research has unveiled the advantages of dedicated PS digestion due to its higher energy content. Anaerobic digestion (AD) of primary sewage sludge can offer a sustainable solution for managing sewage sludge while generating renewable energy. The present study provides a comprehensive examination of the current state of knowledge regarding the anaerobic digestion of PS. Co-digestion of PS with organic substrates, including food waste and agro-industrial residues, emerges as a promising approach to boost biogas production. Additionally, the utilization of additives such as glucose and clay minerals has shown potential in improving methane yield. Critical factors affecting AD, such as pretreatment methods, carbon-to-nitrogen (C/N) ratio, temperature, pH, volatile fatty acids (VFAs) levels, organic loading rates (OLR), inoculum-to-substrate ratio (ISR), and the role of additives, have been meticulously studied. Finally, this review consolidates existing knowledge to advance our understanding of primary sewage sludge anaerobic digestion, fostering more efficient and sustainable practices in sludge management and renewable energy generation.