From the Guidelines
The standard dose of bicalutamide for prostate cancer is 150 mg taken once daily by mouth, as supported by the most recent and highest quality study 1. This dose is typically used for locally advanced disease, and it can be considered as an alternative adjuvant to LHRH agonist therapy in men who place a high value on retaining sexual function during treatment. Some key points to consider when using bicalutamide for prostate cancer include:
- Bicalutamide should be taken at the same time each day with or without food.
- When used with an LHRH analog, bicalutamide is usually started at the same time or 3 days before the LHRH analog to prevent tumor flare.
- Bicalutamide works by blocking androgen receptors, preventing testosterone from binding to these receptors in prostate cancer cells, thereby inhibiting cancer cell growth.
- Common side effects include breast pain, breast enlargement, hot flashes, and decreased libido.
- Liver function should be monitored periodically during treatment, as recommended by the European Society for Medical Oncology 1. It's also important to note that men starting long-term (>6 months) bicalutamide should consider prophylactic RT to both breast buds within the first month of treatment or use of tamoxifen, as suggested by the ESMO clinical practice guidelines 1.
From the FDA Drug Label
Bicalutamide tablets 50 mg daily is indicated for use in combination therapy with a luteinizing hormone-releasing hormone (LHRH) analog for the treatment of Stage D2 metastatic carcinoma of the prostate. The dose of bicalutamide used for prostate cancer is 50 mg daily in combination with a luteinizing hormone-releasing hormone (LHRH) analog for the treatment of Stage D2 metastatic carcinoma of the prostate 2.
- The 150 mg daily dose is not approved for use alone or with other treatments.
From the Research
Bicalutamide Dosage for Prostate Cancer
- The dosage of bicalutamide used for prostate cancer treatment varies depending on the stage of the disease and whether it is used as monotherapy or in combination with other treatments 3, 4, 5, 6.
- For advanced prostate cancer, a 50-mg daily dose of bicalutamide is often used in combination with a luteinizing hormone-releasing hormone (LHRH) analogue or surgical castration 3, 4, 6.
- As monotherapy, a 150-mg daily dose of bicalutamide is considered effective for locally advanced prostate cancer, offering disease-free survival benefits and improved health-related quality-of-life scores compared to surgical or medical castration 3, 4, 5.
- Higher doses of bicalutamide (up to 600 mg) have been evaluated in clinical trials, but the 150-mg daily dose is generally considered sufficient for monotherapy 3, 6.
- The choice of bicalutamide dosage is supported by its pharmacodynamic profile, tolerability, and efficacy in clinical trials, with the 50-mg dose being suitable for combined androgen blockade and the 150-mg dose being evaluated for monotherapy 3, 4, 6.