Treatment Name: Bicalutamide (Casodex®)
Bicalutamide (Casodex®) is a Chemotherapy Regimen for Prostate Cancer
How does bicalutamide work?
Bicalutamide slows the growth of prostate cancer cells and decreases the size of tumors. In prostate cancer, androgens bind to androgen receptors and cause the cancer cells to grow. Bicalutamide is known as an anti-androgen and it works by blocking androgen receptors inside prostate cancer cells so that androgens, such as testosterone, cannot stimulate the cancer to grow or divide.
Goals of therapy:
When the disease is metastatic, bicalutamide is not commonly given with the goal of cure but is given to slow the growth of prostate cancer and decrease symptoms from prostate cancer. If the disease is not metastatic, it may be given after surgery with or without radiation therapy with the goal of cure.
Usual bicalutamide (Casodex®) starting dose for metastatic disease:
- Bicalutamide 50 mg tablet by mouth once daily
Usual bicalutamide (Casodex®) starting dose for non-metastatic disease:
- Bicalutamide 150 mg (three 50 mg tablets) by mouth once daily
Bicalutamide is usually taken at home. If the disease is not metastatic, it is typically taken for 2 years. If the disease is metastatic, therapy with bicalutamide is typically continued until the drug no longer works or unacceptable toxicity is experienced.
In clinical studies, the most commonly reported side effects of bicalutamide (Casodex®) are shown here. Side effects sometimes have percentage ranges [example: 9 – 53%] because they differed between clinical studies:
- Hot flashes (9 - 53%)
- Swelling of breast tissue with breast pain (48%)
- Breast pain (18%)
- Swelling of breast tissue [gynecomastia] (17%)
- Diarrhea (5 - 12%)
- Blood in the urine (4 - 12%)
- Flu-like symptoms (9%)
- Back pain (8%)
- Impotence (8%)
- Urinary tract infection (8%)
- Constipation (8%)
- High blood pressure (1 - 8%)
- Abdominal pain (7%)
- Weakness (7%)
- Joint pain (7%)
- Sore throat (7%)
- Infection (7%)
- Trouble controlling bladder (6%)
- Rash (6%)
- Weight gain (6%)
- Generalized pain (5%)
- Hernia (5%)
- Inflammation of lung airways (5%)
- Drowsiness (5%)
- Shortness of breath (2%)
Roughly 10 - 25% of patients discontinue bicalutamide due to unacceptable side effects.
Note: Blood in the urine was not related to treatment with bicalutamide in 98% of patients who experienced this.
How often is monitoring needed?
Labs (blood tests) may be checked before treatment then and periodically during treatment. Labs often include: Comprehensive Metabolic Panel (CMP), prostate specific antigen (PSA), plus any others your doctor may order.
How often is imaging needed?
Imaging may be checked before treatment and periodically during treatment at the discretion of your doctor. Imaging may include: computerized tomography (CT) scans and positron emission tomography (PET) scans.
How might blood test results/imaging affect treatment?
Depending upon the results your doctor may advise to continue this treatment as planned, or delay, or switch therapy.
- Gynecomastia (swelling of the breast tissue) has mostly been reported in trials of bicalutamide using the 150 mg daily dose. The frequency of gynecomastia with 50 mg daily is rare
- Bicalutamide may be given days or weeks before starting an injectable medication known as a LHRH agonist (example: leuprolide acetate, Lupron® or Eligard®). The timing is important to prevent tumor flare.
- A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
- Clinical trials may exist for prostate cancer. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications
Patient Assistance & Co-payment Coverage
Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Bicalutamide (Casodex®), we have provided links that may help.
Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Bicalutamide (Casodex®). Depending upon your income, they may be able to help cover the cost of:
For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.
- If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.
Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Bicalutamide (Casodex®) and are the best source to help you understand drug cost.
- Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.
What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.
Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.
Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.
Learn more about pursuing emotional wellness while receiving treatment with Bicalutamide (Casodex®)