An anti-androgen for prostate cancer
Bicalutamide
A tablet hormone therapy for prostate cancer that blocks testosterone's effect on cancer cells.
What is Bicalutamide?
Bicalutamide is a hormone-therapy tablet for prostate cancer. It is an anti-androgen, which means it blocks the effect of testosterone (the male hormone that prostate cancer feeds on) on the cancer cells, helping to slow the cancer. It is started by a cancer specialist and taken once a day at home. The most common effects are breast tenderness or swelling and hot flushes, and because it can affect the liver, you will have blood tests to monitor this. It does not work by causing a low white-cell count, so it does not carry the infection risk of chemotherapy.
Education and reference only. This is a plain-language guide to Bicalutamide — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Bicalutamide is a hormone therapy (an anti-androgen) used to treat prostate cancer. It comes as a tablet taken by mouth, usually once a day, and is taken at home as part of treatment planned by a cancer specialist. It may be used on its own, alongside other hormone treatments, or with radiotherapy, depending on the situation. Unlike chemotherapy, it works by blocking a hormone rather than directly attacking dividing cells.
How it works
Prostate cancer cells are usually driven to grow by male hormones called androgens, the main one being testosterone. Bicalutamide attaches to the docking points (receptors) that testosterone would normally use on the cancer cells, blocking the hormone's message to grow. This slows the cancer and can shrink it. Because it blocks testosterone's effects more widely in the body, it can cause effects such as breast tenderness and hot flushes.
Company & origin
Originated / developed by: Generic (specialist cancer medicine).
A hormone-therapy tablet used in the UK for prostate cancer, started by a cancer specialist and usually taken at home.
Practical use
How to take Bicalutamide
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it once a day as prescribed, at about the same time each day, with or without food.
- Take it regularly even when you feel well, as it works by keeping the hormone effect blocked over time.
- Go to your blood tests, especially in the first few months, so your liver can be monitored.
- Report yellowing of the skin or eyes, dark urine, severe tiredness or ongoing sickness, as these can be signs of a liver problem.
- Tell your specialist if breast tenderness or swelling is troubling you, as there are ways to help reduce it.
Weighing it up
Advantages & disadvantages of Bicalutamide
Advantages
- A convenient daily tablet taken at home for prostate cancer.
- Does not lower the infection-fighting white cells the way chemotherapy does.
- Can be used on its own or combined with other hormone treatment or radiotherapy.
Disadvantages
- Commonly causes breast tenderness and breast enlargement.
- Can cause hot flushes, tiredness and reduced interest in sex.
- Needs liver monitoring with blood tests, especially early on.
Practical use
Good to know
Bicalutamide is taken as a daily tablet at home, which many people find more straightforward than treatments given in hospital. The most noticeable effects come from blocking testosterone: breast tenderness and breast enlargement (called gynaecomastia) are common, and hot flushes can occur; your team can sometimes suggest ways to reduce breast effects, such as preventive radiotherapy or another medicine. Because bicalutamide can affect the liver, you will have blood tests, particularly in the first few months, and you should report yellowing of the skin or eyes, dark urine, severe tiredness or persistent sickness. It can also cause tiredness and a lower interest in sex. It is started and supervised by a specialist, who will review how well it is working and how you are tolerating it. It is a medicine for prostate cancer in men and is not for use in women or children.
Who should not take it / use with caution
- It is for prostate cancer in men and must not be used in women or children.
- People who have had a serious allergic reaction to bicalutamide should not take it.
- It is used with care in significant liver problems, with monitoring.
Monitoring
- Blood tests to check liver function, especially in the first few months.
- Regular PSA blood tests and reviews to see how well the cancer is being controlled.
- Reviewing side effects such as breast changes and hot flushes, and how they can be eased.
Side effects
- Breast tenderness and breast enlargement, and hot flushes.
- Tiredness, reduced interest in sex, and sometimes dizziness.
- Changes in liver blood tests; rarely, signs of a liver problem such as yellowing of the skin or eyes that need checking.
Key interactions
- It can affect warfarin, so people on warfarin may need closer INR monitoring.
- Tell your team about all your medicines, as some can interact with hormone therapy.
- It is often combined deliberately with other prostate cancer treatments under specialist guidance.
Available as: Tablets taken by mouth, usually once a day.
Answers
Bicalutamide: frequently asked questions
Why does bicalutamide cause breast tenderness or swelling?
By blocking testosterone, it shifts the hormone balance, which can make breast tissue tender or enlarged; your specialist can sometimes offer preventive radiotherapy or another medicine to reduce this.
Does it lower my immune system like chemotherapy?
No. Bicalutamide is a hormone therapy that blocks testosterone's effect; it does not lower the infection-fighting white cells the way chemotherapy does.
Why do I need blood tests?
Bicalutamide can affect the liver, so blood tests, especially in the first few months, check your liver is coping, alongside PSA tests to see how the cancer is responding.
Can I take it with my other tablets?
Usually yes, but it can affect warfarin and some other medicines, so tell your team everything you take so they can check and monitor as needed.
Will it affect my interest in sex?
It can reduce interest in sex and cause tiredness in some men; tell your specialist if this is troubling you, as it can be discussed and sometimes managed.
Authoritative sources
- BNF
- NICE CKS
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