Casodex® for Prostate Cancer Treatment

Reviewed by: HU Medical Review Board | Last reviewed: July 2022

Casodex® (bicalutamide) is an androgen receptor inhibitor, also called an antiandrogen or a nonsteroidal antiandrogen (NSAA), used in combination with other hormone therapies called LHRH agonists (also called GnRH agonists). It is indicated for use in individuals with metastatic prostate cancer (prostate cancer that has spread to other parts of the body). Bicalutamide is an orally administered medication that comes in tablet form. Individuals taking bicalutamide should also be monitored for changes in liver functioning as well as for any changes in blood glucose or prostate-specific antigen (PSA).

How does Casodex® work?

Bicalutamide’s active ingredient binds to the androgen receptors in the body. Bicalutamide blocks testosterone and other androgens from activating these receptors. Prostate cancer tumors are often fueled to grow by androgens, including testosterone. Turning off the body’s ability to respond to testosterone can potentially halt tumor growth. In addition, bicalutamide can be used during early stages of other hormone therapies, such as treatment with Gonadotropin-Releasing Hormone (GnRH) agonists, in order to block the initial surge of testosterone, called tumor flare, that can come along with these medications. The surge of testosterone at the beginning of some of these treatment methods can contribute to rapid tumor growth before it is halted, potentially leading to life-threatening issues such as spinal cord compression.

What are the possible side effects of Casodex®?

Multiple clinical trials evaluated the safety and efficacy of bicalutamide. The most common side effects of bicalutamide include hot flashes, weakness, difficulty breathing, dizziness, pain in general, infection, nausea, constipation, swelling of the limbs, diarrhea, anemia, increased urinary frequency, especially at night, and blood in the urine. These are not all the possible side effects of bicalutamide. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with bicalutamide.

Things to note about Casodex®

Several less common but more serious side effects can accompany bicalutamide including problems with your liver. Individuals should be closely monitored for signs of these serious side effects, and blood tests to assess liver function should be performed regularly. Patients should take their medication as prescribed by their doctor. Patients should talk to their doctor if they have any questions, or if they have questions regarding their bicalutamide regimen. Alert your provider immediately if you notice any of the following symptoms:

  • Nausea and vomiting
  • Stomach or abdominal pain
  • Flu-like symptoms like soreness or muscle aches
  • Fatigue
  • Brown urine
  • Yellowing of the skin or whites of eyes (jaundice)
  • Loss of appetite
  • Inability to urinate
  • Difficulty breathing

Additionally, using bicalutamide with LHRH (or GnRH) agonists may affect blood glucose levels. Individuals taking bicalutamide should have their blood glucose regularly monitored. Also, treatment with bicalutamide may lead to breast pain and swelling in men.

Before starting bicalutamide talk to your provider if you:

  • Have any liver problems
  • Are taking any blood thinners
  • Have diabetes or poor sugar control
  • Have a partner who is pregnant or could become pregnant
  • Have any other medical conditions
  • Are currently taking any other medications (prescription and over-the-counter), vitamins, or herbal supplements

You should also contact your provider if you notice any signs of an allergic reaction to the medication, including chest pain or difficulty breathing. Skin sensitivity has been reported with bicalutamide, so it is important to use sunscreen and avoid sunlamps, tanning beds, and excessive sunlight if possible. It is also important to consult the prescribing information for any other medications taken with bicalutamide, including LHRH agonists.

Receiving Casodex®

Bicalutamide is administered orally and is commonly taken with a LHRH (or GnRH) agonist. Your provider will determine the appropriate dosage and administration schedule for you, as well as the appropriate dosage and administration of any other medications taken with bicalutamide. It is important to follow this schedule exactly as instructed, and not to stop taking bicalutamide or any accompanying medications on your own.1

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