Bicalutamide in advanced prostate cancer - once daily does it

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IN BRIEFBicalutamide is a nonsteroidal antiandrogen given once daily. At a dosage of 50 mg/day this agent is at least as effective as flutamide 250mg 3 times daily when used in maximal androgen blockade (MAB) regimens.Increasing the bicalutamide dosage from 50 to 150 mg/day has improved its efficacy as monotherapy in patients with non-metastatic disease, but patients with metastatic disease respond better to castration. Importantly, sexual interest appears to be better preserved with bicalutamide monotherapy than with castration.Unlike nilutamide, bicalutamide has not been causally associated with problems such as interstitial pneumonitis and difficulty with light/dark adaptation. In addition, bicalutamide 50 mg/day causes a lower incidence of diarrhoea than flutamide 750 mg/day.Therefore, bicalutamide is an attractive option in patients with advanced prostate cancer who are suitable to receive MAB regimens. The role of bicalutamide monotherapy in the management of this common malignancy is currently being assessed.

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