Bicalutamide (Casodex®)

This information is about a hormonal therapy called bicalutamide, which is also commonly called Casodex®. It is used to treat prostate cancer. The information should ideally be read with our general information about prostate cancer.

Casodex Back to top

Casodex is a type of hormonal therapy that is used in the treatment of prostate cancer.

There are several different hormonal therapies. Your doctor can discuss with you which is best for your particular situation.

How Casodex works Back to top

Hormonal therapies interfere with the production or action of particular hormones in the body. Hormones are substances produced naturally in the body. They act as chemical messengers and help to control the activity of cells and organs.

Casodex has a structure similar to the male sex hormone testosterone. It works by preventing testosterone from attaching (binding) to the receptors on the surface of the prostate cancer cells. Without testosterone the cancer cells either grow more slowly or stop growing altogether. The cancer may shrink in size as a result.

How it is taken Back to top

Casodex is a tablet, which is taken once a day. It is available in two different strengths: 50mg and 150mg.

When it may be given Back to top

Casodex may be used to treat prostate cancer that has begun to spread into the tissues around the prostate gland (locally advanced). It can either be given on its own or after surgery| or radiotherapy|.

In prostate cancer which has spread to other parts of the body (advanced or metastatic cancer), Casodex may be given in combination with injections of another type of hormonal-therapy drug (called a pituitary downregulator) such as goserelin|, buserelin|, triptorelin| or leuprorelin|. These drugs block the production of a hormone produced by the pituitary gland (leuteinising hormone), which stimulates the production of testosterone.

For men with prostate cancer that is contained within the prostate gland (early prostate cancer) Casodex may be given as a short-term treatment (a few weeks only) to prevent 'tumour flare'. This is a temporary increase in symptoms that can occur when a man first starts treatment with a pituitary downregulator.

You will see your doctor regularly while you have this treatment so that they can monitor the effects. This information should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, who are in the best position to help and advise you.

Possible side effects Back to top

Each person's reaction to any medication is different. Many people have very few side effects with Casodex, while others may experience more. The side effects described here will not affect everyone and may be different if you are having more than one drug. We have outlined the most common side-effects. However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or nurse.

You will see your doctor regularly while you have this treatment so that they can monitor the effects. This information should help you to discuss any queries about your treatment and its side effects with your doctor or nurse, as they are in the best position to help and advise you.

Some people may have some of the following side effects:

Breast tenderness or fullness Many men may notice breast swelling and tenderness known as gynaecomastia. Your doctor can prescribe medicines or other treatments to reduce any discomfort.

Hot flushes There are a number of ways to help reduce hot flushes and sweats. It can be useful to avoid or cut down on tea, coffee, nicotine and alcohol. Let your doctor know if hot flushes are causing you any problems, as research suggests that some treatments may be helpful in controlling this side effect.

Some men find that complementary therapies| help. Your GP may be able to give you details about obtaining these on the NHS.

Itching and dryness of the skin This is usually mild. Let your doctor know if it is a problem for you. Sometimes creams or medicines can reduce this effect.

Nausea (feeling sick) If you experience any nausea it is usually mild and easily controlled. Nausea| can sometimes be relieved by taking the tablet with food. Let your doctor know if you have any nausea, as they can prescribe medicines to help.

Lowered sex drive (libido) and erection difficulties (impotence) This will usually return to normal after stopping the drug. Your doctor or nurse can discuss this with you.

Lowered sex drive (libido) and erection difficulties (impotence) Let your doctor or nurse know if this is a problem as there are medicines or treatment that may be able to help. These effects usually return to normal after stopping hormonal treatment.

Weakness Sometimes Casodex may cause feelings of weakness.

Weight gain You may notice that you put on weight, especially around the waist or chest.

Less common side effects Back to top

General pain Some men experience pain|, especially in the tummy (abdomen) or the back. Let your doctor know if you develop any new pain, as they can give you simple painkillers.

Liver changes let your doctor know if you've ever had any problems with your liver. They may need to take regular blood tests to make sure Casodex isn't affecting your liver.

Length of treatment Back to top

Your doctor will discuss the length of treatment that they feel is appropriate for your situation. Casodex is often given for several months or years. Treatment may continue for as long as it is effective in controlling your cancer.

Things to remember about Casodex tablets Back to top

Casodex may interact with other medicines, such as drugs to prevent blood clots (anti-coagulants) and some drugs that treat blood pressure and heart conditions. Let your doctor know about any medicines you're taking. This includes non-prescribed drugs such as complementary therapies and herbal drugs.

• Keep the tablets in a safe place out of the reach of children, as Casodex could harm them.
• If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
• Don't worry if you forget to take your tablet. The levels of the drug in your blood will not change very much, but try not to miss more than one or two tablets in a row. Let your doctor or nurse know.
• Remember to get a new prescription a few weeks before you run out. Make sure you have plenty for holidays.

References Back to top

This section has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.

For further references, please see the general bibliography|.