SLC25A45 and posterior cortical atrophy: An optimized, cross-validated model combining L-acetylcarnitine/TML and sarcosine/putrescine effectively mitigated physiological noise to achieve robust diagnostic separation, yielding an area under the curve (AUC) of 0.99.<h4>Conclusions</h4>Ultimately, this study provides a discovery-phase proof-of-concept for the SLC25A45-TML axis as a mechanistically grounded, stage-independent liquid biopsy, offering a rational, non-invasive framework to significantly improve PCa detection.