In this multicentric cohort study involving Chinese PCa patients receiving ADT, we newly identified four germline SNPs: rs36119043 in AKR1D1, rs151155810 in HSD17B12, rs71179009 in SULT2B1, and rs28609134 in SRD5A3 that were significantly associated with increased risk of ADT failure. Here, AKR1D1 is linked to posterior cortical atrophy.