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Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), before treatment and at 1\u2010 and 3\u2010year follow\u2010ups. Probable cognitive impairment (PCI) was defined using age\u2010 and education\u2010adjusted cut\u2010offs. Model\u2010based clustering and clinical interpretability were used to identify cognitive trajectories. Adjusted odds ratios (aORs) were estimated using multinomial logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Four cognitive trajectories were identified: (1) consistently high (highest scores throughout follow\u2010up); (2) moderate\u2010stable (stable intermediate scores); (3) moderate\u2010downward (intermediate baseline scores and declining over the follow\u2010up); and (4) consistently low (lowest baseline scores). PCI prevalence increased over time in the moderate\u2010downward trajectory (8.1%\u201333.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and remained high in the consistently low trajectory (29.8%\u201332.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.537). Compared with the consistently high trajectory, age (\u2265\u00a075 vs.\u00a0\u2264\u00a065: OR\u00a0=\u00a04.00; 95% CI: 1.61\u20139.93), education (\u2265\u00a010 vs.\u00a0\u2264\u00a04\u00a0years: aOR\u00a0=\u00a00.02; 95% CI: 0.01\u20130.06), and depressive symptoms (per one\u2010point increase in the Hospital Anxiety and Depression Scale: aOR\u00a0=\u00a01.12; 95% CI: 1.01\u20131.24) were associated with the consistently low trajectory. Androgen deprivation therapy (ADT) was associated with the moderate\u2010downward trajectory (aOR\u00a0=\u00a02.33; 95% CI: 1.01\u20135.36).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Four distinct cognitive trajectories were identified among men with PCa over 3\u00a0years, with worse trajectories associated with sociodemographic, psychological distress, and treatment\u2010related factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70604","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T06:13:02Z","timestamp":1789020782000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cognitive Trajectories and Associated Factors in Prostate Cancer Survivors Over a 3\u2010Year Prospective Study"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2588-8141","authenticated-orcid":false,"given":"Adriana","family":"Costa","sequence":"first","affiliation":[{"name":"EPIUnit ITR Instituto de Sa\u00fade P\u00fablica Universidade do Porto  Porto Portugal"},{"name":"Departamento de Ci\u00eancias da Sa\u00fade P\u00fablica e Forenses e Educa\u00e7\u00e3o M\u00e9dica Faculdade de Medicina Universidade do Porto  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5787-4871","authenticated-orcid":false,"given":"Milton","family":"Severo","sequence":"additional","affiliation":[{"name":"EPIUnit ITR Instituto de Sa\u00fade P\u00fablica Universidade do Porto  Porto Portugal"},{"name":"Instituto de Ci\u00eancias Biom\u00e9dicas Abel Salazar Universidade do Porto  Porto 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