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Objective To investigate the relationships between blood lipids and the risk of recurrence after radical prostatectomy (RP). Methods Totally 161 prostate cancer patients undergoing RP were enrolled, including 68 cases of medium-low prognosis risk and 93 cases of high prognosis risk. After a follow-up period of 3 years, biochemical recurrence was observed in 45 patients while no biochemical recurrence occurred in 116 patients. The general data, laboratory examination results, Gleason score and clinical stage of the subjects were collected. A comparison of the collected data was made between the medium-low risk group and the high-risk group, as well as between the biochemical recurrence group and the non-recurrence group. Indexes with statistically significant differences were included in the multivariate Logistic regression model to identify the risk factors associated with high prognosis risk and biochemical recurrence. Results Compared with the medium-low risk group, the high-risk group exhibited a higher abnormal rate of HDL-C and an elevated level of Lp (a)（both P<0. 05). Multivariate Logistic regression analysis revealed that abnormal HDL-C level was a high risk factor for prognosis of patients after RP (P<0. 05). The abnormal rates of HDL-C and Lp (a), the levels of Lp (a) and PSA, the proportions of Gleason score ≥8 and clinical stage ≥T2c were higher in the recurrence group than in the non-recurrence group (all P<0. 05). Multivariate Logistic regression analysis showed that high-grade clinical stage (≥T2c), elevated PSA level and abnormal Lp (a) level were risk factors for recurrence in patients undergoing RP (all P< 0. 05). Conclusions The abnormal serum HDL-C and Lp (a) are associated with the high prognosis risk and biochemi⁃ cal recurrence in patients undergoing RP. [ABSTRACT FROM AUTHOR]