Casodex (bicalutamide) is a hormone therapy, usually used in conjunction with a luteinizing hormone-releasing hormone (LHRH), to combat advance prostate cancer when the cancer has started to spread to other areas of the body.

This medication is an androgen receptor inhibitor, which means, when treating prostate cancer, it inhibits the ability of testosterone receptors found on the cancer to utilize testosterone. Deprived of testosterone, which most prostate cancers thrive on, the cancer will stop growing and may begin to shrink.

Casodex is almost always given along with an LHRH; LHRH medications further reduce the cancer's access to testosterone by telling the body to stop producing the hormone.

Treatment with Casodex

Casodex is typically prescribed for as long as it is effective; treatment may last months or years, either until the cancer is gone or treatment no longer seems to be providing any benefit.

Taking Casodex is fairly straightforward:

• Tablets are taken once daily, usually in the morning but some patients prefer evening.
• The bladder should be emptied before tablets are taken.
• For maximum effectiveness tablets should be taken at the same time each day.
• Casodex may be taken with or without food.
• Staying hydrated is important during treatment.
• Missed doses can be taken as soon as remembered.

LHRH treatments are usually given by a doctor; either as a skin implant which releases medication over time, or as an injection given every 1, 3 or 6 months. LHRH treatment may begin at the same time as Casodex treatment, or it may be delayed for several weeks.

Treatment should not be stopped or interrupted without doctor approval. Stopping treatment may cause symptoms to worsen.

Frequent check-ups and blood tests are typically recommended during treatment, to monitor for developing adverse effects as well as to ensure the medication is working properly. Doses may be adjusted during treatment. If treatment stops being effective, there are numerous other, similar therapies which may be tried. Patients are strongly advised to attend regular check-ups.

Warnings & Side Effects

Some side effects are fairly common, affecting about 30% of men, though it is quite rare for any individual to experience all common side effects. Most side effects are completely reversible when treatment stops, and dangerous adverse reactions are very rare. Alcohol consumption may worsen side effects.

Most common side effects include:

• Hot flashes
• Decreased libido (interest in sex)
• Impotence (inability to achieve an erection)
• Swollen or painful breasts
• Constipation or diarrhea
• Nausea or vomiting
• Infertility

The above side effects can often be minimalized with other treatments; speak to a doctor about options.

More dangerous side effects call for immediate medical attention:

• Difficulty breathing
• Blood in urine
• Chest pain
• Urine retention (unable to urinate for more than 8 hours)
• Excessive vomiting (unable to keep food or medications down)

Very rarely Casodex may be prescribed to women. In general women should avoid use of this medication, and women who are pregnant, trying to become pregnant, or breast feeding should not even handle tablets; the medication can cause severe birth defects and interfere with reproductive development. Likewise, keep this medication out of reach of children and pets; even traces of residue may be absorbed into the skin. 

Certain preexisting conditions, such as diabetes or liver disease, put patients at greater risk of serious adverse effects. Risks should be discussed with a doctor prior to treatment, and alternative therapies may be desirable.

Casodex may interact with numerous other prescription medications, causing unpleasant side effects or reducing effectiveness. Be sure your doctor is aware of all medications being taken before starting treatment.