This study investigated the efficacy of using plasma-activated water (PAW) as a novel and additive-free pretreatment in reducing the formation of free and bound heterocyclic aromatic amines (HAAs) and advanced glycation end products (AGEs) in roasted fish patties. PAW activated for different durations (50 s, 100 s, and 150 s), significantly decreased the levels of HAAs and AGEs. The highest inhibition rates were observed at 35.44% and 19.82% for free and bound HAAs, respectively, and 42.76% and 23.23% for free and bound AGEs, respectively. PAW pretreatment reduced the formation of HAAs and AGEs and mitigated their increase during storage. Analysis using electron paramagnetic resonance and UPLC-MS/MS showed a decrease in free radicals and reactive carbonyls (phenylglyoxal, glyoxal, and methylglyoxal), which can serve as intermediates for HAAs and AGEs. Correlation analysis indicated a significant positive correlation between HAAs/AGEs and phenylacetaldehyde, glyoxal, methylglyoxal, and the total spin number (P < 0.05). This suggests that PAW suppresses the production of reactive carbonyls by quenching free radicals, thereby inhibiting the formation of HAAs and AGEs. In conclusion, with its additive-free approach, PAW pretreatment holds promise for reducing HAAs and AGEs and improving the safety of roasted fish products.