This paper delves into the imperative need for coexistence and compatibility in the 470–694 MHz frequency band, as mandated by the World Radiocommunication Conference 2015 (WRC-15) and the WRC-23. It focuses on challenges in the coexistence of Digital Terrestrial Television Broadcasting (DTTB) and International Mobile Telecommunications-2020 (IMT-2020) services in downlink-only mode, particularly in adjacent-channel scenarios. Using Monte Carlo simulations, the study evaluates the probability of interference from IMT base stations with DTTB reception. The analysis thoroughly investigates the impact of the IMT transmitter’s Adjacent Channel Leakage Ratio (ACLR) and the DTTB receiver’s Adjacent-Channel Selectivity (ACS) on the probability of interference. The results demonstrate a significant degradation in the DTTB reception probability at the edge of coverage based on standard assumptions. To address these challenges, this paper provides recommendations for mitigating interference. These include defining enhanced ACLR regulations for IMT base stations, implementing antenna discriminations, providing specialized filters, and establishing national coordination procedures. The research provides valuable insights for informed decision making in spectrum management within the 470–694 MHz band, aiming to facilitate the coexistence of DTTB and IMT-2020 services, in line with international regulations and best practices.