In this multicentric cohort study, four novel germline SNPs were identified to significantly increase the risk of ADT failure in Chinese PCa patients: rs36119043 in AKR1D1, rs151155810 in HSD17B12, rs71179009 in SULT2B1, and rs28609134 in SRD5A3. Here, SRD5A3 is linked to posterior cortical atrophy.