Altered metabolism is one of the key molecular characteristics of prostate cancer (PCa) development, and a number of studies have searched for metabolic biomarkers in patient-derived samples. Reported metabolic changes in PCa tissue compared with normal tissue include reduced levels of citrate and spermine, elevated lipid synthesis and fatty acid oxidation, and higher levels of the amino acids alanine, glutamine, and glutamate. Recent studies have investigated the tumor microenvironment, such as reactive stroma, and so-called metabolic field effects. Furthermore, analysis of blood and urine samples reveals other, but significant, metabolic differences between patients with PCa and controls. Large-cohort studies show promising results for assessing future PCa risk from blood samples. In addition, metabolic profiling of extracellular vesicles from urine has gained interest as a noninvasive and more prostate-specific approach to diagnose PCa
