Phosphoglycerate kinase 1 (PGK1) is an essential enzyme in the aerobic glycolysis pathway. PGK1 catalyzes the reversible transfer of a phosphate group from 1, 3-bisphosphoglycerate to ADP and produces 3-phosphoglycerate and ATP. In addition to cell metabolism regulation, PGK1 is involved in multiple biological activities, including angiogenesis, autophagy and DNA repair. Because of its multi-faceted functions, PGK1’s involvement in cancer development is complicated. High intracellular expression of PGK1 leads to tumor cell proliferation. However, high extracellular expression of PGK1 suppresses cancer malignancy through a suppression of angiogenesis. PGK1 is also associated with chemoradiotherapy resistance and poor prognosis of cancer patients. In this manuscript, we summarize the influence of PGK1 and its post-translational modifications on cancer initiation and progression. PGK1-mediated drug resistance and potential small molecule inhibitors targeting PGK1 are discussed for their future clinical applications.