Pancreatic steatosis is defined as the ectopic accumulation of fat in the pancreas. While historically considered a benign incidental imaging finding, it is now recognized as a significant and potentially reversible risk factor for pancreatic ductal adenocarcinoma (PDAC) independent of obesity. Although its epidemiology is not well characterized, meta-analysis data suggest an approximately 30% prevalence, with individual studies reporting even higher rates among patients with obesity and/or metabolic syndrome. Concurrently, PDAC incidence is rising and is projected to soon become the second leading cause of cancer-related deaths. Given the critical importance of early PDAC detection and intervention for improving survival, it is particularly timely to explore the associations between pancreatic steatosis and PDAC. This review aims to provide a comprehensive overview of the pathogenesis and clinical associations between pancreatic steatosis and PDAC and to discuss future perspectives within the context of current PDAC surveillance practices.