Phosphogypsum (PG) is the main by-product of phosphoric acid production, and its large amount of storage has caused serious burden to the environment. In view of the serious environmental pollution caused by PG accumulation, it is necessary to speed up the research on PG pretreatment and comprehensive utilization. In this paper, the pretreatment methods and comprehensive utilization status of PG are reviewed, aiming to provide reference for improving the utilization rate of PG as resources. PG contains many impurities, such as phosphorus, fluorine, organic matter, heavy metals and radionuclides, which limit its application in construction, chemical industry, agriculture and environment. Pretreatment methods include physical method, chemical method and heat treatment method. In terms of comprehensive utilization, PG can be used in the construction field to prepare cement, cement retarder and construction gypsum, in the chemical field to prepare ammonium sulfate, high-purity calcium carbonate and calcium sulfate whisker, in the agricultural field as a soil conditioner and preparation of compound fertilizer, and in the environmental field, PG can be used to adsorb pollutants and store CO2. The comprehensive utilization of PG has broad prospects, but there are still many aspects that need to be made efforts. Future research needs to focus on the development of low-cost, low-energy and environment-friendly PG treatment technology, accelerate the rational utilization of PG resources, and achieve a win–win situation of economic benefits and environmental protection.