Casodex (Bicalutamide) Monotherapy

Various testosterone inactivating pharmaceuticals (TIP) are used to treat prostate cancer.  This post addresses Casodex (Bicalutamide) as a stand-alone therapy with the goal of reducing side effects commonly associated with more potent types of TIP like Lupron.

Casodex has Fewer Side Effects

Casodex has fewer side effects than Lupron because it blocks testosterone’s activity instead of completely eradicating testosterone from the blood as Lupron does.  Men on Casodex tend to experience less fatigue and a more moderate loss of libido* compared to men on Lupron.  Other types of TIP-related side effects may be partially or completely correctable with medication.  For example, osteoporosis can be prevented with a medication called Prolia.  For more information on hormone therapy side effects read our blog, Counteracting Hormone Therapy Side Effects. 

Gynecomastia is Worse with Casodex

Whereas most side effects are diminished by substituting Casodex for Lupron— gynecomastia, or breast growth, occurs more frequently on Casodex.  Gynecomastia occurs in 10–20% of men treated with Lupron but it occurs in up to 50% of men on Casodex.  Gynecomastia is usually preventable.  One approach is to administer radiation to the nipples and surrounding chest over a one-to two-week period before starting the Casodex.   Alternatively, anti-estrogen pills such as Femara can be used.  

Rare Liver Problems

Liver damage is a unique risk of Casodex that does not occur with Lupron.  Within the first month or two, everyone starting Casodex must have a routine blood screening test to check their liver function.  If a liver abnormality is detected, Casodex should be stopped immediately.  While TIP is ongoing, routine blood testing is generally performed every three months.

Casodex Dosing

Casodex is generally a simple medication to use.   It does not react with other medications.  It can be taken any time of the day with or without food.  The dosing is flexible, ranging from 50 mg weekly up to 150 mg daily depending on the clinical goal.  Larger doses are used when a stronger anticancer effect is desired.  Lower doses are associated with fewer side effects. 

When to Use Casodex

Lupron is considered the standard when it comes to hormone therapy.   Since Casodex is somewhat less potent than Lupron, it should only be substituted for Lupron when the cancer is of a low-grade nature or when the patient is unable to tolerate Lupron due to being elderly or frail.  The advantage of Casodex monotherapy is that it allows men to benefit from TIP’s anticancer benefits but with fewer side effects and better quality of life.  Also, Casodex doesn’t have ongoing lingering effects after treatment is stopped, as is the case with Lupron.


Selecting therapy for prostate cancer is complex.  Multiple factors need to be considered prior to selecting treatment including the cancer’s stage, the patient’s age and vitality, and each individual’s quality-of-life goals.  Take the prostate cancer staging quiz at to find stage specific treatment options.   

*Note that libido is different than impotence.  Impotence is the inability to get an erection, libido is the lack of sexual desire.  Viagra and Cialis can help maintain potency even in the absence of libido. 

1 thought on “Casodex (Bicalutamide) Monotherapy

  1. JOHN F MARTIN Reply

    How low will the PSA go with with Casodex and how long will it take to get there?

Leave a Reply

Your email address will not be published. Required fields are marked *