Bicalutamide is a hormone therapy used to treat prostate cancer.

HOW DOES BICALUTAMIDE WORK?

Hormones are substances produced naturally in the body. These act as chemical messengers and help control the activity of cells and organs. Hormone therapies interfere with the way hormones are made or formed in the body.

Most prostate cancers need the hormone testosterone to grow. Almost all of the testosterone in men is made by the testicles. A small amount is made by the adrenal glands, which are located above the kidneys.

Bicalutamide blocks testosterone from reaching the cancer cells. Without testosterone, the prostate cancer may shrink or stop growing.

WHEN IS BICALUTAMIDE GIVEN?

Early prostate cancer

This happens when the cancer is only in the prostate and has not spread to other parts of the body. Bicalutamide can be given over the short term (over a number of weeks) with other treatments for early prostate cancer. It is used to manage a condition called tumor flare, which can happen to you when starting hormone treatments such as goserelin, buserelin, triptorelin, or leuprorelin. Tumor flares are caused by a temporary increase in testosterone levels; this can lead to an increase in symptoms, such as problems urinating. Bicalutamide can be given during the first weeks of these treatment so that this does not happen.

Advanced prostate cancer

Bicalutamide is also used to treat prostate cancer that has spread to other parts of the body (advanced prostate cancer). Bicalutamide can be used before or after surgery or radiotherapy. It can be administered alone or with other hormone treatments such as goserelin, buserelin, triptorelin, or leuprorelin, which lower testosterone levels. Your doctor or nurse will explain how long you are going to be undergoing treatment with bicalutamide. The treatment can go on for as long as it works in controlling your cancer.

TAKING YOUR BICALUTAMIDE TABLETS

Bicalutamide is taken once a day in tablet form. Take it at the same time each day. Swallow the tablets whole with a glass of water. Always take the pills exactly as your nurse or pharmacist has told you. This is important to ensure that it is working as well as possible.

• It is important that you not stop taking any of your tablets if not told to do so by your doctor. Here are some important things to remember:
• If you forget to take a pill, do not take a double dose. Just take your normal dose the next day. The levels of the drug in your blood won't change much.
• Keep the pills in their original packaging at room temperature. They should be stored away from heat and direct sunlight.
• Keep them safe and out of the reach of children.
• Get a new prescription before the one you have runs out, and keep track of holidays, when pharmacies may be closed.
• Return the remaining pills to the hospital if the treatment is discontinued.

POSSIBLE SIDE EFFECTS OF BICALUTAMIDE

You may experience some of the side effects mentioned here, though it is rare for a patient to have all of them. If you are taking other drugs, you may have certain side effects that are not listed here.

Always inform your doctor or nurse of the side effects you experience. They can prescribe drugs to help control them and can also give you advice on managing side effects.

CHEST SWELLING OR SENSITIVITY

This is a common side effect of long-term treatment with bicalutamide. It is called gynecomastia. Your doctor can give you advice on how to prevent or treat this. You may have one or two treatments with low-dose radiotherapy to the breast tissue, or weekly treatment with a hormone drug.

SEXUAL EFFECTS

Bicalutamide may reduce your sex drive or may make you have difficulty with erections. Your nurse or doctor can give you information on this and, if necessary, refer you to specialist support services.

HOT FLASHES AND SWEATING

These are common and can be mild or more severe. While having a hot flash, you feel warmth in the neck and face, and your skin may turn red. Mild hot flashes can last from a few seconds to about a couple of minutes. More severe hot flashes can last 10 minutes or more. You may have sweats and then feel chills and clamminess. Some people feel anxious or irritable during a hot flash.

There are things you can do to try to reduce your hot flashes such as giving up nicotine, alcohol, and hot beverages containing caffeine, such as coffee and tea.

If the hot flashes are bothersome, your doctor can prescribe medication to help lessen them.

Hot flashes and sweating get better as your body adapts to the hormone treatment. They usually stop completely a few months after the treatment ends.

ANEMIA (LOW RED BLOOD CELLS)

Bicalutamide may lower the number of red blood cells in your blood. Red blood cells transport oxygen throughout the body. If you have a low number of red blood cells, you may be tired and short of breath. Tell your doctor or nurse if you feel like this.

SKIN RASHES OR DRYNESS

Occasionally, people develop mild skin rashes. This often gets better without treatment. Tell your doctor if you develop a skin rash.

NAUSEA

This is normally mild. It can help if you take your bicalutamide pills with food. Your doctor can prescribe antiemetic drugs if this is necessary.

WEIGHT GAIN AND LOSS OF MUSCLE STRENGTH

You may gain weight—especially in the waist—and you may lose some muscle strength. Eating a healthy diet and staying physically active can help you control your weight. Talk to your doctor or nurse for further advice.

CHANGES TO YOUR HAIR

Some men notice that their hair thins out, though this is usually mild. Others may find that their hair thickens during the treatment.

CONSTIPATION OR DIARRHEA

Bicalutamide can cause constipation. Drinking at least two liters of fluids each day will help if this is the case. Try to eat more high-fiber foods such as fruit, vegetables, and whole-grain bread and get some light exercise.

Let your doctor or nurse know if this happens. They can give you medication to help with bowel movements (laxatives).

Occasionally, bicalutamide can cause diarrhea. Drink at least two liters of fluids each day if you have diarrhea. Your doctor can prescribe pills for diarrhea if necessary.

ABDOMINAL OR BACK PAIN

You may have stomach or back pain, feel bloated, have indigestion or feel gassy. Peppermint capsules and mint tea can help with indigestion or gas. Tell your doctor if your pain or discomfort doesn't go away or if it worsens. They can prescribe medication to help these symptoms get better.

BLOOD IN URINE

You may have blood in your urine while taking bicalutamide. This is quite common. Let your doctor or nurse know if this happens.

DIZZINESS OR DROWSINESS

Tell your doctor or nurse if you have any of these symptoms. It is important not to drive or operate machinery if you feel this is the case.

LESS COMMON SIDE EFFECTS OF BICALUTAMIDE

ALLERGIC REACTION

On rare occasions, bicalutamide can cause allergic reactions. The signs of a reaction may include the following: rash, itchiness, flushed or short of breath, swelling in the face or lips, or feeling dizzy or unwell. Get in touch with your doctor immediately if you have any of these symptoms.

EFFECTS ON THE LIVER

Bicalutamide can sometimes affect the liver. Your doctor will perform blood tests on you to see if your liver is functioning properly. The effect is usually mild and does not prevent you from continuing to take bicalutamide. Tell your doctor if you notice any yellowish coloring on your skin or in your eyes.

BREATHLESSNESS

On rare occasions, bicalutamide can cause people to feel short of breath. If you feel breathless while taking bicalutamide, tell your doctor immediately.

MORE INFORMATION ON BICALUTAMIDE

OTHER DRUGS

Bicalutamide can interact with other drugs. This includes medications that can be purchased in a supermarkets or pharmacies. Tell your doctor if you are taking any other medication. These include complementary therapies, antihistamines, vitamins, and herbal remedies.

MEDICAL TREATMENT

If you have to go to the hospital for whatever reason other than cancer, always tell the doctors and nurses that you are taking bicalutamide. Explain that you are taking hormone therapy and that no one should start or stop it without taking to your cancer specialist in the first place.