PURPOSE: To investigate the association between ABO blood types and clinicopathological characteristics in patients with prostate cancer (PC). METHODS: A total of 237 pathologically diagnosed PC patients were enrolled. All patients were classified as low-middle or high-risk group. The correlation of ABO blood types with high-risk PC was determined by univariate and multivariate regression analysis. RESULTS: Data indicated 144 (85.7%) patients were stratified as high risk in the non-O group, while 50 (72.5%) patients in the O group ( = 0.025). However, there was no significant difference regarding PSA, Gleason score, stage, or metastasis between O and non-O group ( > 0.05). Univariate logistic regression analyses revealed PSA, Gleason score, and blood type non-O were all correlated with high-risk PC (OR = 1.139, < 0.001; OR = 9.465, < 0.001; OR = 2.280, = 0.018, resp.). In the stepwise multivariate regression analysis, the association between blood type non-O and high-risk PC remained significant (OR = 33.066, 95% CI 2.391-457.323, and = 0.009) after adjusting for confounding factors as well as PSA and Gleason score. CONCLUSION: The present study firstly demonstrated that non-O blood type was at higher risk of aggressive PC compared with O type, suggesting that PC patients with non-O blood type should receive more attention in clinical practice.