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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.


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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.

Side Effects

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.

Side effect videos Side Effect Videos
PainPainDiarrheaDiarrheaConstipationConstipationFatigue Fatigue BleedingBleeding


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.

ChemoExperts Tips

  • 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 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:

  • Bicalutamide

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.

Emotional Wellness

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®)

Individual Drug Label Information

Bicalutamide (Casodex®)

  • Is a oral tablet that is available in a strength of 50 mg. Can be taken with or without food at the same time each day
  • Can be taken in the morning or evening
  • If you miss a dose, take the next dose at the normal scheduled time and do not double the next dose
  • Store at room temperature in a cool, dry place
  • May cause increased blood levels of warfarin (Coumadin®). If you are on warfarin therapy, you may need your INR checked more frequently after starting therapy with bicalutamide
  • May cause fetal harm if given to a pregnant woman. Bicalutamide has no indication for use in women so therefore its use is contraindicated in all women
General side effects from bicalutamide (Casodex®)
  • May caused liver injury. Call your doctor immediately if you notice yellowing of the skin or eyes
  • Can cause swelling of breast tissue and breast pain when used at high doses (150 mg) - known as gynecomastia
  • Patients commonly experience hot flashes while receiving therapy with bicalutamide
  • May cause weakness, drowsiness, and flu-like symptoms
  • Can cause back or joint pain
  • Some patients may experience impotence (loss of sexual function)
  • May cause abdominal pain, constipation, or diarrhea
  • May cause high blood pressure
  • Can cause trouble controlling bladder, bladder infection, or blood in the urine 
  • Sore throat
  • Rash
  • Weight gain
  • Inflammation of lung airways 
  • Shortness of breath
  • Click on the bicalutamide (Casodex®) package insert below for reported side effects and possible drug interactions

Side Effect Videos
DiarrheaDiarrheaFatigue Fatigue ConstipationConstipationPainPain

See DailyMed package insert.

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1) Wirth M, Tyrrell C, Wallace M, et al. Bicalutamide (Casodex) 150 mg as immediate therapy in patients with localized or locally advanced prostate cancer significantly reduces the risk of disease progression. Urology. 2001;58:146-151.

2) Schellhammer PF, Sharifi R, Block NL, et al. Clinical benefits of bicalutamide compared with flutamide in combined androgen blockage for patients with advanced prostate carcinoma: final report of a double-blind, randomized, multicenter trial. Urology. 1997;50:330-336.

Created: January 15, 2017 Updated: October 7, 2018

What is Prostate Cancer?

A disease of the cells found in the prostate gland in men.  Prostate cancer is a common condition caused by abnormal growth and rate changes in the prostate gland cells that form tumors.  The stage of prostate cancer can vary at diagnosis and throughout treatment.  The staging includes both the TNM + Grade, which is based on exam of tissue removed by surgery, and clinical staging: Stage I, IIa, IIb, III, IV.  The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What are Androgens?

Steroids made naturally by your body in the testes, and adrenal glands. Some prostate tumors are able to use androgens to grow and divide.

What does Cure mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below:

1) Wirth M, Tyrrell C, Wallace M, et al. Bicalutamide (Casodex) 150 mg as immediate therapy in patients with localized or locally advanced prostate cancer significantly reduces the risk of disease progression. Urology. 2001;58:146-151.

2) Schellhammer PF, Sharifi R, Block NL, et al. Clinical benefits of bicalutamide compared with flutamide in combined androgen blockage for patients with advanced prostate carcinoma: final report of a double-blind, randomized, multicenter trial. Urology. 1997;50:330-336.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

14) Serum calcium

What is PSA?

An enzyme that is produced by cells of the prostate. PSA is normally found in small amounts in the blood but may be elevated in patients with prostate cancer or other conditions of the prostate such as prostatitis (inflammation of the prostate) and benign prostatic hyperplasia (BPH). An elevated level of PSA in the blood does not diagnose prostate cancer, but may be used to help monitor response to treatment or to monitor for disease relapse

What is metastatic disease?

Metastatic disease is when cancer cells have spread from their primary (original) location to other parts of the body and started more tumor(s).