Hi everyone,

Recently my dad was diagnosed with prostate cancer, and as preparation for radiotherapy he is undergoing treatment to shrink his prostate, and this will involve first bicalutamide (an anti-androgen) and then zoladex, which targets the precursors of testosterone. Zoladex I knew about (it has been discussed here in the past) but bicalutamide I'd not heard of before. It seems to take the place of androcur/cyproterone.

Has anyone had experience of it? How does the experience compare to androcur? I found that drug ineffective (not sure if the drug itself was, for me, or if I had a bad batch, but others said the drug from the same supplier worked for them). I know it's more expensive and therefore must be a newer drug.

(BTW his cancer was said not to be very aggressive but obviously did warrant treatment. I've been told there are ten grades (10 is worst) and his is grade two to three. It's not believed to be metastatic.)

I believe it is the commonest anti-androgen (anti-testosterone) medication used for prostate cancer now.

There's lots about it at https://en.wikipedia.org/wiki/Bicalutamide .

There's a passage comparing it with cyproterone (Androcur):

Comparison

See also: Comparison of bicalutamide with other antiandrogens

The side effect profile of bicalutamide in men and women differs from that of other antiandrogens and is considered favorable in comparison.[120][92][121][122] Relative to GnRH analogues and the steroidal antiandrogen (SAA) cyproterone acetate (CPA), bicalutamide monotherapy has a much lower incidence and severity of hot flashes and sexual dysfunction.[100][92][95][123] In addition, unlike GnRH analogues and CPA, bicalutamide monotherapy is not associated with decreased bone mineral density or osteoporosis.[95][92] Conversely, bicalutamide monotherapy is associated with much higher rates of breast tenderness, gynecomastia, and feminization in men than GnRH analogues and CPA.[95] However, gynecomastia with bicalutamide is rarely severe and discontinuation rates due to this side effect are fairly low.[95][92] These differences in side effects between bicalutamide monotherapy, GnRH analogues, and CPA are attributed to the fact that whereas GnRH analogues and CPA suppress estrogen production, bicalutamide monotherapy does not lower estrogen levels and in fact actually increases them.[95]

Bicalutamide does not share the high risk of neuropsychiatric side effects like depression, anxiety, and suicidality as well as cardiovascular side effects like coagulation changes, thrombosis, fluid retention, ischemic cardiomyopathy, and adverse serum lipid changes that CPA is associated with.[123][124][125][126] It has a far lower risk of hepatotoxicity than flutamide and CPA and of interstitial pneumonitis than nilutamide.[127][92][128][129][88][130] The drug also does not share the unique risks of diarrhea with flutamide and nausea, vomiting, visual disturbances, and alcohol intolerance with nilutamide.[92][123][129] Unlike enzalutamide, bicalutamide is not associated with seizures or related central side effects like anxiety and insomnia.[131][132] However, although the risk of adverse liver changes with bicalutamide is low, enzalutamide differs from bicalutamide in having no known risk of elevated liver enzymes or hepatotoxicity.[133][134] In contrast to the SAA spironolactone, bicalutamide does not have antimineralocorticoid effects,[135] and hence is not associated with hyperkalemia, urinary frequency, dehydration, hypotension, or other related side effects.[60][136][137][123] In women, unlike CPA and spironolactone, bicalutamide does not produce menstrual irregularity or amenorrhea and does not interfere with ovulation or fertility.[45][138]

Hope it helps...

Hope your dad does great on his treatment. I've not had prostate cancer, but have had several surgeries and treatments.

Physically it has always been greater than I expected. Mentally, it can be really difficult.

I can tell you that the one thing that got me through was the help of family and friends. So, the doctors, the medications, the radiation will all help him get better. Yet, still, you and your family will be the most important part of his recovery.

Sometimes, he will be hard to get along with. Just do what you know needs doing. Later, he'll look back on it and be very grateful you and the rest of his support group were there to help.

When my dad had an blood clot in his brain, they wouldn't let him bend over for a few weeks. He recovered 100% use of his body because they got it fast and did surgery.

Now, you'd think that not being able to put a dish onto the bottom shelf of the dishwasher would have been the least of his concerns. But, "leave the dish on the counter and I'll put it in the dishwasher when I see it," apparently wasn't something he was willing to go along with. So, we dealt with it.

You'll find your own dragons to slay and you'll be both his hero and sometimes his sounding board. Remember, he loves you and you love him. It will all work out. He's lucky to have you.