Bicalutamide (Casodex)

Bicalutamide is a form of hormone therapy called an anti-androgen. One brand name for this drug is Casodex.

Bicalutamide and other anti-androgens work by stopping testosterone from reaching the cancer cells. Without testosterone the prostate cancer cells are not able to grow. Bicalutamide will not cure prostate cancer but it can keep the cancer under control for many months or years.

 

How do I take bicalutamide?+

Bicalutamide comes as 50mg and 150mg tablets. You should swallow the tablets whole with a drink of water. Try and take the tablet at the same time every day. The amount you take will depend on why you need the drug. There are three main reasons for taking bicalutamide.

Flare
If you are about to start treatment with another type of hormone therapy drug called an LHRH agonist, you may take bicalutamide to prevent the body's normal response to the first injection of this drug, which is to produce testosterone. This temporary rise in testosterone could cause the cancer to grow more quickly for a short time. This is known as flare. An anti-androgen tablet like bicalutamide can help to prevent this flare from happening. You will start taking the tablets a week or so before the first LHRH agonist injection and continue taking them for two weeks afterwards. It is important that you take all the tablets you have been given.

Treating locally advanced prostate cancer
You may take a 150mg dose of bicalutamide once a day to treat cancer that has spread to the area just outside the prostate gland (locally advanced cancer). If you have locally advanced prostate cancer you may have bicalutamide alongside radiotherapy.

Treating advanced prostate cancer
If your cancer has spread to other parts of the body (advanced cancer) you may take a 50mg dose of bicalutamide once a day together with an LHRH agonist or orchidectomy (surgery to remove the testicles). This is called maximal androgen blockade.

What are the side effects?+

Like all drugs, bicalutamide can cause side effects in some men. The risk of side effects may vary depending on the dose you are taking. We have listed the most common ones1 here but you should tell your specialist team if you notice any other changes while you are having treatment.

Some men get very few side effects and others get more. Many side effects will only last for as long as you are taking the drug. However, if you take bicalutamide for a long period of time, it may take several months after you finish treatment for the side effects to stop.

You can find out more about the side effects of hormone therapy and ways that you can manage them by reading our booklet Living with hormone therapy: A guide for men with prostate cancer.

Before you take bicalutamide, you should tell your doctor if:

  • You have liver problems. You may need regular blood tests to make sure that your liver is coping for the first few months of treatment.
  • You are taking any prescription or over-the-counter medicines. In particular, drugs that prevent blood clots, treat allergic reactions (anti-histamines) or treat high blood pressure.

If you have any questions or worries about any side effects, speak to your specialist team. You can also call our confidential Helpline.

Breast swelling and tenderness
Some men may experience breast swelling (gynaecomastia) and tenderness in the breast area. This can affect one or both breasts and can range from mild sensitivity to ongoing pain. The amount of swelling can also vary from a small amount to a more noticeable enlarged area. Your doctor may recommend treating the breast area with radiotherapy, before you start on bicalutamide. A single low dose of radiation may reduce the risk of breast swelling and tenderness.2

Hot flushes
Hot flushes give you a sudden feeling of warmth in the upper body and can be similar to those experienced by women going through the menopause. A few men may also find that they sweat more than they used to. Hot flushes can vary from a few seconds of feeling overheated to a few hours of sweating that can stop you from sleeping or cause discomfort.

Loss of sex drive and erectile dysfunction
Men taking bicalutamide may lose their desire for sex (libido). Some men may also have problems getting and keeping an erection (erectile dysfunction). In most cases this will last as long as you are on hormone therapy and may take a while to return to normal if you stop the treatment.

Tiredness
You may feel tired and have trouble sleeping whilst you are taking bicalutamide. You may find that your tiredness improves over time but many men find that regular exercise gives them more energy and helps them to cope with treatment.3

Bowel problems
You may find that you have more frequent, loose or watery bowel movements (diarrhoea). Some men may also have difficulty emptying their bowels (constipation). Your specialist team will be able to suggest ways to manage these problems.

Weight gain
You may put on weight, particularly around the waist or chest. Exercise and a healthy diet can help you stay a healthy weight.

Itchy skin
You may have itchy skin or a rash on any part of the body but this is usually mild. Moisturising creams and lotions may help.

Other side effects
Some men taking bicalutamide may develop anaemia, which can cause them to feel weak, or breathless. You may also find that you feel dizzy, have chills and have some pain in your pelvis. Speak to your specialist team about how you can manage these side effects.

Reporting unusual side effects: the Yellow Card scheme+

If you think you are experiencing a side effect from your medication that is not mentioned in the information leaflet that comes with it, then you can report it using the Yellow Card Scheme. This is run by the Medicines and Healthcare products Regulatory Agency (MHRA). They will investigate and if they find a problem with a medication then the MHRA will take action to protect the public. There are three ways you can report a side effect:

  • Use the online Yellow Card form
  • Ask your pharmacist for a Yellow Card form
  • Call the Yellow Card freephone on 0808 100 3352
How long will I need to take bicalutamide?+

The length of time you take bicalutamide for depends on why you are taking it and how well it is working.

Speak to your specialist team or call our confidential Helpline for information on other treatments that can be used if hormone therapy is no longer controlling the cancer.

More information+

To find out more about hormone therapy you can read:

Reviewers+

Reviewed by:

  • Vanessa Basketter, Uro-oncology Nurse Specialist, St. Marys Hospital, Portsmouth
  • Mr Simon F Brewster, Consultant Urological Surgeon, Churchill Hospital, Oxford and Honorary Senior Clinical Lecturer in Surgery, University of Oxford
  • Bruce Turner, Uro-oncology Nurse Practioner, Homerton University Hospital NHS Foundation Trust and Whipps Cross University Hospital NHS Trust, London
  • Deborah Victor, Urology Cancer Clinical Nurse Specialist, Royal Cornwall Hospitals NHS Trust, Truro
  • Cathryn Woodward, Consultant Clinical Oncologist, Addenbrooke's Hospital, Cambridge
  • The Prostate Cancer Charity Information Volunteers
  • The Prostate Cancer Charity Support & Information Specialist Nurses

Written and edited by:
The Prostate Cancer Charity Information Team

References+

References used in the production of this page

1 Public Assessment Report. Bicalutamide 50mg film-coated tablets/ Bicalutamide 150mg film-coated tablets. Medicines and Healthcare products Regulatory Agency. May 2009. Available at: http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con046567.pdf

2 Haddad E. Management of gynaecomastia induced by bicalutamide Ann Urol 2006; Dec;40 Suppl 2:S49-52.

3 Segal RJ, Reid RD, Courneya KS et al. Resistance training in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology 2003; 21: 1653-1659.