Care During Chemotherapy and Beyond



Trade name: Casodex® uses generic names in all descriptions of drugs. Casodex is the trade name for bicalutamide. In some cases, health care professionals may use the trade name casodex when referring to the generic drug name bicalutamide.

Drug type:  Bicalutamide is a hormone therapy.  It is classified as an "anti-androgen." Often given in combination with "LHRH agonist," another type of hormone therapy. (For more detail, see "How this drug works" section below).

What Bicalutamide Is Used For:

  • Bicalutamide therapy is for men with advanced prostate cancer at stage D2, when there is evidence of metastases (cancer spread) to other areas of the body.

Note: If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.  

How Bicalutamide Is Given:

  • Bicalutamide is a pill, taken by mouth.  It is taken once a day and is usually started at the same time LHRH therapy is started. 
  • It should be taken at the same time each day, with or without food.
  • You should empty your bladder (urinate) before taking the medication.
  • In some cases (e.g. spinal cord metastasis), bicalutamide will be started approximately 5-7 days before you receive the LHRH agonist.  This is done to block the "flare" or surge of testosterone that occurs after LHRH agonist is given.
  • The amount of this medicine you receive depends on many factors.  Your doctor will determine your dose and schedule. 

Side Effects:

Important things to remember about the side effects of bicalutamide:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration.
  • Side effects are almost always reversible and will go away after treatment is complete.
  • There are many options to help minimize or prevent side effects.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking bicalutamide (with LHRH agonist):

  • Hot flashes (see sexuality)
  • Swelling of the breasts (gynecomastia) (see sexuality)
  • Breast pain (see sexuality)
  • Loss of interest in sex (decreased libido) (see sexuality)
  • Inability to obtain or sustain an erection (impotence) (see sexuality)

These are less common (occurring in 10-29%) side effects for patients taking bicalutamide (with LHRH agonist):

  • Constipation
  • Diarrhea
  • Nausea
  • Increases in blood tests measuring liver function.  These return to normal once treatment is discontinued (see liver problems).
  • Fertility, meaning your ability to father a child, may be affected by bicalutamide.  Please discuss this issue with your health care professional.

Not all side effects are listed above, some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms: 

  • Chest pain
  • Difficulty breathing 
  • Urinary retention or inability to urinate (for 8-12 hours).
  • The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:
  • Nausea (interferes with ability to eat and unrelieved with prescribed medication).
  • Vomiting (vomiting more than 4-5 times in a 24 hour period).
  • Diarrhea (4-6 episodes in a 24-hour period).

Always inform your health care provider if you experience any unusual symptoms.


  • Before starting bicalutamide treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). 
  • Diabetic patients should carefully monitor their serum glucose.
  • Do not discontinue this medicine without first talking with your caregiver.
  • Anti-androgens are usually given to men.  However, if bicalutamide is given to a woman, conceiving a child (getting pregnant) should be avoided.
  • Anti-androgens are usually given to men.  However, if bicalutamide is given to a woman, she should not breast feed.
  • Anti-androgens are usually given to men.  This drug should not be given to women who are pregnant or intend to become pregnant.  Pregnancy category X (bicalutamide may cause fetal harm when given to a pregnant woman.  This drug must not be given to a pregnant woman or a woman who intends to become pregnant.  If a woman becomes pregnant while taking bicalutamide, the medication must be stopped immediately and the woman given appropriate counseling).

Self-Care Tips:

  • Do not stop taking this medication unless your healthcare provider tells you to. Take the medication exactly as directed.
  • Take at the same time each day. 
  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • If you are experiencing hot flashes, wearing light clothing, staying in a cool environment, and putting cool cloths on your head may reduce symptoms. Consult you health care provider if these worsen, or become intolerable.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
  • Get plenty of rest. 
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your doctor while you are taking bicalutamide, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How Bicalutamide Works:

Growth of prostate cancer may be stimulated by male hormones (androgens, primary testosterone) circulating in the body.  Reducing the amount of these hormones in a man with prostate cancer can help fight the disease.  This is often referred to as "hormone therapy."

Hormones are chemical substances that are produced by glands in the body, which enter the bloodstream and cause effects in other tissues.  For example, the hormone testosterone, made in the testicles and is responsible for male characteristics such as deepening voice and increased body hair.  The use of hormone therapy to treat cancer is based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells.  Hormone therapy can work by stopping the production of a certain hormone, blocking hormone receptors, or substituting chemically similar agents for the active hormone, which cannot be used by the tumor cell. Different types of hormone therapies are categorized by their function and/or the type of hormone that is affected.

Bicalutamide is categorized as an antiandrogen.  Antiandrogens are substances that block the effects of testosterone. Cancer of the prostate depends on the male hormone testosterone for its growth.  If the amount of testosterone is reduced it is possible to slow down or shrink the cancer.

Antiandrogens are usually given with LHRH agonists (leutenizing hormone - releasing hormone).  LHRH agonists work by telling the pituitary gland located in the brain to stop producing leutinizing hormone, which (in men) stimulates the testicles to release testosterone and (in women) stimulates the ovaries to release estrogen.  The drug does not have a direct effect on the cancer, only on the testicles or ovaries.   The resulting lack of testosterone (in men) and estrogen (in women) interferes with stimulating cell growth in testosterone or estrogen dependent cancer cells.

Examples of LHRH agonists are:

  • goserelin acetate (Zoladex®)
  • leuprolide acetate (EligardTM)
  • Lupron®
  • ViadurTM
  • triptorelin pamoate (TrelstarTM)

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice. is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit