Objective To explore clinical risk factors for metastatic prostate cancer. Methods We retrospectively analyzed the clinical data of 180 patients with prostate cancer diagnosed with pathological examination during their first hospitalization in the Department of Urology of the Affiliated Hospital of North Sichuan Medical College from January 2019 to March 2024，involving the patients’ age，body mass index，Gleason score，and preoperative parameters including the ratio of free prostate-specific antigen（FPSA） to total prostate-specific antigen（TPSA），plasma fibrinogen level，neutrophil count，platelet count，lymphocyte count，monocyte count，neutrophil-to-lymphocyte ratio（NLR），platelet-to-lymphocyte ratio（PLR），monocyte-to-lymphocyte ratio（MLR），the systemic immune-inflammation index（SII），prostate volume，TPSA level，alkaline phosphatase level，and smoking and alcohol drinking history. Among the patients，99 were diagnosed as localized prostate cancer，and 81 were diagnosed as metastatic prostate cancer. The Mann-Whitney U test，χ² test，and multivariable logistic regression analysis were performed to determine clinical risk factors for metastatic prostate cancer. Results The univariable analyses detected significant differences in the body mass index（U=-2.456，P<0.014），Gleason score（U=6.801，P<0.001），plasma fibrinogen level（U=3.360，P=0.001），lymphocyte count（U=-2.963，P=0.003），NLR（U=2.096，P=0.036），PLR（U=2.503，P=0.012），MLR（U=2.434，P=0.015），TPSA level（χ²=30.462，P<0.001），and alkaline phosphatase level（χ²=36.719，P<0.001）. The multivariable logistic regression analysis incorporating these significant indicators showed that a decreased body mass index，an increased Gleason score，TPSA level >20 ug/L，and alkaline phosphatase level ≥90 ng/mL were independent risk factors for metastatic prostate cancer. Conclusion For newly diagnosed patients with prostate cancer，those with a low body mass index，a high Gleason score，TPSA level >20 ug/L，and alkaline phosphatase level ≥90 ng/mL should be further evaluated to determine whether metastasis occurs.