Objective To analyze the dynamic changes in symptom clusters among prostate cancer patients undergoing androgen deprivation therapy, and to provide a reference for symptom management. Methods A longitudinal descriptive study design was employed. A total of 170 prostate cancer patients undergoing androgen deprivation therapy were enrolled. The Simplified Chinese Version of the Aging Males′ Symptoms Rating Scale was used to assess the incidence and severity of symptoms on the first (T1), second (T2), and third (T3) month of endocrine therapy. Results A total of 150 patients completed the survey. The number of symptoms at T1, T2 and T3 was (4.52±2.02), (7.63±3.26) and (10.84±2.18), respectively, showing an increasing trend (P<0.05). Exploratory factor analysis identified 3,5 and 5 symptom clusters at T1, T2 and T3, with the cumulative variance contribution rates of 62.17%, 64.58% and 63.02%, respectively. Among them, sexual function symptom cluster, muscle and skeletal muscle symptom cluster, and psychological symptom cluster persisted across T1, T2 and T3. The endocrine-metabolic symptom cluster and energy deficiency symptom cluster emerged at T2 and T3. Conclusion Within the first three months of androgen deprivation therapy, the incidence and severity of symptoms in prostate cancer patients gradually increase. Nurses should dynamically assess and strengthen management strategies that are coordinated across multiple symptoms.