Background: Little is known about how pre-diagnostic metabolites in blood relate to risk of prostate cancer. We
aimed to investigate the prospective association between plasma metabolite concentrations and risk of prostate
cancer overall, and by time to diagnosis and tumour characteristics, and risk of death from prostate cancer.
Methods: In a case-control study nested in the European Prospective Investigation into Cancer and Nutrition,
pre-diagnostic plasma concentrations of 122 metabolites (including acylcarnitines, amino acids, biogenic amines,
glycerophospholipids, hexose and sphingolipids) were measured using targeted mass spectrometry (AbsoluteIDQ
p180 Kit) and compared between 1077 prostate cancer cases and 1077 matched controls. Risk of prostate cancer
associated with metabolite concentrations was estimated by multi-variable conditional logistic regression, and
multiple testing was accounted for by using a false discovery rate controlling procedure.Results: Seven metabolite concentrations, i.e. acylcarnitine C18:1, amino acids citrulline and trans-4-hydroxyproline,
glycerophospholipids PC aa C28:1, PC ae C30:0 and PC ae C30:2, and sphingolipid SM (OH) C14:1, were associated with
prostate cancer (p < 0.05), but none of the associations were statistically significant after controlling for multiple testing.
Citrulline was associated with a decreased risk of prostate cancer (odds ratio (OR1SD) = 0.73; 95% confidence interval (CI)
0.62–0.86; ptrend = 0.0002) in the first 5 years of follow-up after taking multiple testing into account, but not after longer
follow-up; results for other metabolites did not vary by time to diagnosis. After controlling for multiple testing, 12
glycerophospholipids were inversely associated with advanced stage disease, with risk reduction up to 46% per
standard deviation increase in concentration (OR1SD = 0.54; 95% CI 0.40–0.72; ptrend = 0.00004 for PC aa C40:3). Death
from prostate cancer was associated with higher concentrations of acylcarnitine C3, amino acids methionine and
trans-4-hydroxyproline, biogenic amine ADMA, hexose and sphingolipid SM (OH) C14:1 and lower concentration
of glycerophospholipid PC aa C42:4.
Conclusions: Several metabolites, i.e. C18:1, citrulline, trans-4-hydroxyproline, three glycerophospholipids and SM
(OH) C14:1, might be related to prostate cancer. Analyses by time to diagnosis indicated that citrulline may be a
marker of subclinical prostate cancer, while other metabolites might be related to aetiology. Several glycerophospholipids
were inversely related to advanced stage disease. More prospective data are needed to confirm these associations.