[Monotherapy with antiandrogens for prostatic cancer]

Bicalutamide (Casodex) is a new antiandrogen, so far approved for the treatment of prostate cancer in combinations with a GnRH agonist. Results from large, well controlled studies show that monotherapy with bicalutamide is an interesting alternative to surgical or medical castration for patients with advanced prostate cancer. The efficacy generally appears to be similar to that of castration, but without the well known side effects of castration such as hot flushes, reduced sexual interest and functioning, and reduced physical capacity. Bicalutamide is well tolerated, but some patients will experience gynaecomastia and/or breast tenderness, and they should be informed about this before treatment is started. Monotherapy with bicalutamide is an attractive first line treatment for these patients in order to maintain optimal quality of life for as long as possible. Studies show that many patients will respond to second line treatment with castration if bicalutamide has failed.