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AimThe aim of our study was to assess the predictive value of controlling nutritional status (CONUT) score for the prognosis of prostate cancer.MethodsA total of 257 patients’ characteristics, prostate‐specific antigen (PSA) values, biopsy, and pathological specimen features were all recorded. The CONUT score was calculated for each patient from three blood parameters: total lymphocyte count (TLC), serum albumin, and cholesterol concentrations. Spearman's correlation coefficient was used to assess the correlation between the total CONUT score and the variables including age, body mass index, prostate volume, PSA, biopsy and pathological specimen features, and PSA‐recurrence free survival (PSA‐RFS) time. The Kaplan‐Meier method and log‐rank test were used for PSA‐RFS analysis. Regression analyses were performed to assess the association between clinicopathological factors, the International Society of Urological Pathology (ISUP) upgrading, and biochemical recurrence (BCR).ResultsStatistically significant differences were determined in pathologic ISUP grade, and total tumor volume between low and high CONUT score groups. Additionally, the high CONUT score group had a significantly higher BCR rate and lower PSA‐RFS when compared with the low CONUT score group. A strong positive correlation between total CONUT score and pathologic ISUP grade and a moderate negative correlation between total CONUT score and PSA‐RFS was determined. In multivariate analysis, a total CONUT score ≥2 had a statistically significant association with ISUP upgrading (odds ratio [OR] = 3.05) and BCR (3.52).ConclusionPreoperative CONUT score is an independent predictive factor for ISUP score upgrading and BCR in patients who undergo radical prostatectomy.