Bicalutamide

How it works

It competitively binds androgen receptors, blocking the action of testosterone and dihydrotestosterone on prostate tissue and inhibiting androgen-dependent tumour growth.

Prescribing in practice

• Can cause hepatotoxicity, including rare severe hepatic injury, so liver function must be checked and treatment stopped if significant abnormality occurs.
• Gynaecomastia and breast tenderness are common, particularly with higher-dose monotherapy.
• When given alone for prostate cancer it is started together with, or just before, a gonadorelin analogue to cover the initial testosterone surge as appropriate.

Monitoring

Monitor liver function periodically and assess prostate-specific antigen and disease response during treatment.

Counselling the patient

• Report yellowing of the skin or eyes, dark urine, nausea or unusual tiredness, which may indicate liver problems.
• Breast swelling or tenderness can occur and should be discussed with your clinician.

Evidence & guidelines

Use is supported by randomised trial evidence in prostate cancer and NICE guidance, with periodic liver-function monitoring advised.