Bicalutamide Side effects 50mg

User

Posted 29 Jan 2020 at 10:22

Hi folks

I’ve been reading some of the side effects some of you have been experiencing on Bicalutamide and I see most of you were on 150mg daily but I’m on50mg and I feel quite scared at the prospect of losing my hair(I’m an old rocker) and the tiredness and nausea. Will this be reduced on the smaller dose? This is a journey I’d rather not be on - getting married soon and I don’t want to be ill. And can I ask when the side effects kicked in? Sorry to ask...

regards The Doc

User

Posted 29 Jan 2020 at 16:19

I was on 50mg for 6 months. It turned out to be too low a dose to do anything much to PSA - only reduced by a small amount.

However, here are the side effects from my diary...

Immediate - Nocturnal erections and morning wood stop. Acne, and very slightly constipated.
3 weeks - Libido reducing. Blood pressure increased by 25mmHg over next 3 weeks.
5 weeks - Semen more watery, urinary flow improving (probably prostate shrinking), acne gone.
9 weeks - Testicles shrinking, harder to reach orgasm.
10 weeks - Semen looks just like water.
11 weeks - Nipple pain.
12 weeks - Breast bud growth - start on Tamoxifen. Body odor has gone (no deodorant needed anymore).
17 weeks - Thinning of body hair on arms, pits, legs, and chest. Pubes and beard not impacted.
25 weeks - Breast bud growth reversed by Tamoxifen. Visceral fat increasing.

Could still get erections on demand, and penis size unchanged, but I got an ED clinic appointment when I started on HT, and was told it was essential to keep generating frequent erections, to prevent penis shrinkage, advice I took very seriously...

Hormone therapy doesn't lose hair on top of head, and can even prevent/reverse balding.

However, everyone is different, and gets different symptoms in a different order.

Hope that's helpful. This was the sort of thing I wanted to know when I started, and it wasn't available anywhere.

I would suggest getting tamoxifen so you are ready if breast pain/growth starts. Many oncos prescribe it with bicalutamide in the first place. Mine refused, but later I got it prescribed the same day when I told them breast bud growth had started, and it completely reversed it when used that quickly. You need to have a liver function blood test 3 months after starting tamoxifen (and periodcially after that), as it's toxic to some peoples' livers.

After 6 months, I was switched to Zoladex, which is more powerful than 50mg bicalutamide (and brought my PSA down very quickly).

Why are you on 50g bicalutamide? In my case (having external beam radiotherapy) it was later recognised as having been the wrong dose. However, I believe it is sometimes used to shrink prostate for brachytherapy.

Edited by member 29 Jan 2020 at 16:28 | Reason: Not specified

User

Posted 08 Apr 2020 at 17:11

If you are hit badly by fatigue, it doesn't make any difference when you take it .... but not everyone suffers the same side effects to the same level anyway.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User

Posted 29 Jan 2020 at 12:43

I was on 150 for 11 months. Knocked me hard for two weeks. Mainly utter fatigue. However after that I coped really well and stayed at work. No loss of hair or weight gain or moobs nor loss of libido etc. I guess on a 50 dose you may be fine. Good luck

User

Posted 29 Jan 2020 at 16:19

I was on 50mg for 6 months. It turned out to be too low a dose to do anything much to PSA - only reduced by a small amount.

However, here are the side effects from my diary...

Hormone therapy doesn't lose hair on top of head, and can even prevent/reverse balding.

However, everyone is different, and gets different symptoms in a different order.

Hope that's helpful. This was the sort of thing I wanted to know when I started, and it wasn't available anywhere.

After 6 months, I was switched to Zoladex, which is more powerful than 50mg bicalutamide (and brought my PSA down very quickly).

Edited by member 29 Jan 2020 at 16:28 | Reason: Not specified

User

Posted 31 Jan 2020 at 18:37

I've been on bicalutamide 50mg for three weeks now. Maybe I'm just lucky but I haven't experienced any side effects at all. Are you staying on it long term or will you be switched to another treatment? I started Zoladex implants last Friday so only have another week to go on the bicalutamide. Hope all goes well for you

User

Posted 31 Jan 2020 at 20:17

"Why are you on 50g bicalutamide?"

I think bical was probably added after he became hormone refractory in November time.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 31 Jan 2020 at 21:33

Bicalutimide can cause loss of body hair, but it doesn't cause loss of head or facial hair. Quite the opposite - your hair may grow more thickly.

I've been on 150mg bicalutimide for 17 months now and side effects have been relatively minor. Breast growth was really the only significant one and that didn't start for over a year. A combination of Tamoxifen and breast-bud RT stopped it.

Best wishes,

Chris

User

Posted 31 Jan 2020 at 22:08

Originally Posted by: Online Community Member

"Why are you on 50g bicalutamide?"

I think bical was probably added after he became hormone refractory in November time.

Ah, if already on hormone therapy, my list of symptoms is probably irrelevant. I was assuming this was starting from nothing.

Edited by member 31 Jan 2020 at 22:08 | Reason: Not specified

User

Posted 09 Feb 2020 at 14:45

not sure if long term but oncology hope the PSA levels drop. I’ve felt a bit nauseous but that’s how I was/am on HT injection. What a bloody journey this is.

User

Posted 10 Feb 2020 at 15:24

So I come at this from 2 separate experiences with bicalutamide at 150 mg daily dose. I was on it for six months from January to July 2016 wrapped around my EBRT. I had the following side effects:

1) Breast soreness and expansion. I found this a bit troublesome if I'm honest, especially the soreness. This subsided when I came off it.

2) Tearful and depressive feelings. They came and went.

3) Tiredness - I needed an afternoon nap - sometimes the desire to sleep was overwhelming.

4) Occasional hot flushes.

I'm now on a 24 month course of bicalutamide (150 mg). 3 tablets in - 727 to go! I am astonished at how quickly the tearful/depressive feelings have come on - quite literally after 2 pills. I expect to get the breast issue again but I have been prescribed Tamoxifen at 20 mg daily to pre-empt this. Tiredness already kicking in.

I was thinking back to 2016 the other day - I wish I'd kept a diary but what I can say is that I started to accept the side effects as the new normal. Before I started the EBRT we did a luxury city break to Palma for 3 nights. We had a great time so the pills did not spoil that.

I am absolutely convinced that exercise is pretty much essential. A walk when the tearful/depressive feelings start was, I found, a life saver. It just lifted my mood.

The hair thing. Body hair thinned but I am excessively hairy so I welcomed that. On my head an odd thing happened, I started to become less grey. No hair loss on the head.

Edited by member 10 Feb 2020 at 15:28 | Reason: Not specified

User

Posted 08 Apr 2020 at 17:00

I have just been diagnosed and first prescription is for Bicalutamide 50mg 3 weeks supply also having a Prostap injection next week.

I see fatigue is a prominent side effect - does it matter when you take it i.e morning or night.

Is there any pros in taking it at night or does the fatigue kick in whenever?

Thanks

User

Posted 08 Apr 2020 at 17:11

If you are hit badly by fatigue, it doesn't make any difference when you take it .... but not everyone suffers the same side effects to the same level anyway.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 16 Apr 2020 at 17:21

My partner had terrible fatigue but 8 0r 9 weeks on and he is feeling much better :)

Some days you just have to create your own sunshine......

User

Posted 21 Jul 2020 at 17:29

Is Bicalutamide the most common hormone therapy men get? Is it the treatment with the least side effects?

My husband Ian, who had a prostectomy in February, will need salvage radiation and hormone therapy. His PSA readings since the operation were: 2.1, 2.1 and a few weeks ago 2.4. The consultant isn't too worried about the slight increase. His bone scan was negative and the MRI showed cancer in two lymph nodes outside the prostate bed, these lymph nodes cannot be removed surgically, due to the proximity to major blood vessels. Finally the appointment for a PET scan came through yesterday, the appointment is for next week. After the PET scan they will probably put Ian on hormone therapy, but we don't know when the radiation will be, with COVID this may be further delayed. The consultant wants Ian's incontinence to improve more anyway, before radiation. Does anyone know how long patients generally wait to have salvage radiation after surgery? I presume it also depends on the cancer; where it is, how high the PSA is, etc.

User

Posted 21 Jul 2020 at 17:46

I forgot to ask- how long are men on HT for when they are having Salvage Radiation? Or does that again depend on certain factors, eg. PSA levels, type of cancer, etc.

User

Posted 21 Jul 2020 at 19:04

Originally Posted by: Online Community Member

Is Bicalutamide the most common hormone therapy men get? Is it the treatment with the least side effects?

No, the wait for RT doesn't depend on the cancer or how high the PSA is, it depends on the particular oncologist's preference. However, almost all men are on hormones for at least 3 months prior to salvage RT - some will be advised to wait 6 months. The wait is because the HT will weaken the prostate cancer cells, making them more susceptible to the RT when it comes. There are a very few oncos who advise men that they don't need HT at all prior to salvage RT but I would be very cautious in that case as research shows it to be less likely to solve the problem.

Which hormone also depends on onco preference - some will say just to have bicalutimide tablets for 6 or 9 mnoths, others will want the man to have Zoladex or Prostap injections for 18 months ... for a while, we were seeing men put on the injections for 3 years but recent research showed that 18 months was just as effective. If anything, some of the side effects can be slightly worse with bicalutimide (breast growth, joint pain, breathlessness) but other side effects are worse with the injections (loss of libido, weight gain, loss of muscle mass, fatigue).

I wouldn't worry about the delay between starting HT and starting RT - the longer the gap, the better in many ways as a) it gives him time to regain continence (difficult having RT if you can't control your bladder properly) and b) the HT should bring the PSA down to an acceptable level.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 21 Jul 2020 at 19:20

The most common hormone therapy drugs are the GnRH Agonists (Zoladex, Prostap, Decapeptyl). These stop your body producing testosterone.

Bicalutamide is an anti-androgen and blocks the androgen receptors, so your body can't use testosterone (which is an androgen). It actually causes your body to produce about 50% more testosterone, but your body can't use it.

Bicalutamide tends to cause fewer or less severe side effects than the GnRH Agonists, with the one exception of breast gland growth, which tends to be worse. Bicalutamide by itself, it's not as effective as the GnRH Agonists, but there are several different reasons you might be on hormone therapy, and they don't all need it to the maximum extent. Bicalutamide is also sometimes preferred for shorter periods (such as up to 6 months neoadjuvant hormone therapy before radical treatment), because it's effect stops more quickly when you stop taking it.

For salvage radiotherapy, using hormone therapy or not, and if so, which type, varies considerably between consultants.

User

Posted 28 Aug 2020 at 15:37

Hi Chris J.,

My husband is worried about the side effects, and spoke to one the Specialist Nurses. She said that is was normal to be on hormone therapy for 2-3 years after completed radiation therapy, so he is freaked out about the time! He is starting on the tablets today (50mg) and after 2 weeks he will get his first injection, and once every 3 months thereafter) I know that every man reacts differently to the hormones. He is worried about the sexual side effects, because 2-3 years is a long time. I heard that some men can get intermittent hormone treatment. At the moment Ian will continue on the daily Cialis and Viagra as an event dose, 2x a week. He is also adamant to use using the pump. Do you know if younger men have fewer side effects? Ian is 57 years old. He is probably going to have to wait 3-6 months before he gets radiation therapy. He will find all this out on 14. September at the appointment with the oncologists. Unfortunately, he has to go alone, but I will have my list of questions for him to ask, as well.

Do you know if one can take herbal supplements for hot flushes, etc? He will ask about that at the meeting. Presently, he was getting immune boosting remedies from our qualified herbalist, but she told him to stop taking her remedy, since it could interfere with the hormone treatment. But of course there are supplements from health food shops for hot flushes, etc.

What has your experience been?

Edited by member 28 Aug 2020 at 15:40 | Reason: Not specified

User

Posted 28 Aug 2020 at 16:29

The onco may have a different view to the specialist nurse - recent research has shown that there is no more benefit to having HT for 3 years than there is for 18 months, and some oncos only ask their patient to have HT for 6 - 9 months for salvage treatment (3-6 months before and 3 months after) but this is more common for men who are on bicalutimide and not the injections.

Hormone holidays (intermittent hormone therapy) is only relevant to men with incurable cancer on long term HT, where their PSA has stayed low and stable for a long period of time - it isn't appropriate for men on salvage treatment.

Age doesn't seem to make any difference to how badly affected men are by HT side effects - some get it bad and some don't. If he is having problems with hot flushes, he can safely take sage tablets, evening primrose oil or try acupuncture.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 02 Sep 2020 at 17:25

So, Lyn, why are some men only on tablets and not on injections as well? Ian started taking 50mg last week, and I think he'll only be on them for 4 weeks, and next week he gets his first 3 monthly injection of Prostap. How are the 3 monthly injections different from the monthly ones? Do men get different doses of the injections? Ian's will be 11.25mg. After a man has completed radiation therapy, does he then go back on only the tablets, or does that depend on several factors? From the posts I've read, there seems to be so many variations.

Also I read some posts about HIFU, is that something we could consider for treatment as well? For my husband's two cancerous lymph nodes? Or what about Focal Laser Ablation and cryrosurgery? Do you know anything about those?

User

Posted 02 Sep 2020 at 18:05

Knodel,

The GnRH Agonist injections (Zoladex, Prostap, Decapeptyl) all need to be started during a short course of an anti-androgen (Bicalutamide or Cyproterone). This is because they initially cause a testosterone flare for a couple of weeks before they shut down testosterone production, and the anti-androgen prevents the flare getting to any tumor.

The injections are available in 1, 3, and 6 monthly injections (varies slightly between each of them). Sometimes, the one monthly is given first (just in case the patient reacts to it), but then switched to 3 or 6 monthly. The 3 monthly has 3 times as much as the one monthly, and dissolves 3 times slower, so the slow release rate of the drug is the same regardless of duration. He will stay on the injections for the duration of the treatment.

Sometimes, hormone therapy is done just by using Bicalutamide (at a higher dose - 150mg). This tends to be used for shorter term hormone treatment, and where the hormone treatment doesn't need to be as effective as the GnRH drugs are.

Your question about duration - it may depend on his PSA values after treatment. I was down for 18-36 months HT. My PSA has been undetectable since radiotherapy 12 months ago, so my onco just told me I can stop the HT anytime from now (which is 18 months on HT). I already have the next injection in the fridge and I'm not getting bad side effects, so I said I'd do that one more which will take me to about 22 months. If my PSA was higher now, and being a high risk patient, my oncologist said he would have insisted on the full 3 years. I did deliberately delay my radiotherapy to get my PSA low before starting, as some research has shown this means you can get away with less HT afterwards.

HIFU, Cryotherapy, and Focal Laser Ablation (focal treatments) are only used for small cancers contained in the prostate.

User

Posted 02 Sep 2020 at 18:24

Knodel,

I do an occasional presentation on how the various different hormone therapy drugs work inside your body.

PCUK recorded one of these and it is available to watch on-demand if you're interested:
How Hormone Therapy Drugs Work

Edited by member 02 Sep 2020 at 18:25 | Reason: Not specified

User

Posted 02 Sep 2020 at 19:56

I was diagnosed in Dec 2016 started on Bical for a couple of weeks or so then on to Decap injections for 2 years. Had radiotherapy at the same time at the front end of my treatment (no pun intended).

Jan 2019 I was taken off all meds and just monitored but found that some cells had migrated to my T5 vertebrae and restarted on Bical in May 2020. I asked to stay on this because there was apparently little loss of sexual function as appeased to be being on the injections.

My big issue is at this time the Bical seems to be interfering with the Levothyroxine I am taking (which is a bugger of a drug) and it is causing me to have slight anxiety feelings and also some feelings or trepidation which I have never had before when on the injections.

Has anyone else had something similar and if so how long does it last and does it go away or will I have to change to the Decap injections to get rid of these feelings? I just want to be me again like I was 4 or 5 months ago

User

Posted 03 Sep 2020 at 00:37

The bigger issue may be that with bone mets, bicalutimide may only be effective for a short time before you have to change to full testosterone blockade anyway so you are sort of delaying the inevitable.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 03 Sep 2020 at 09:37

I am probably moving to the Injections when I have my catch up on 15th.

I have had these strange feelings before when I was sort of overdosed on Levothyroxine, this was before my cancer was diagnosed, so I am pretty sure the feelings are to do with that drug but it is not something I have seen in any documents/instruction leaflets, so just wondered if anyone else had experienced it.

Levo is a bugger to get out of your system as the half life is so long.

Thanks for your words. I

should have known a couple of weeks ago what my PSA was doing recently but my Dr surgery lost the bloods they took or at least they didn't get to Pathology at the hospital.

I have another one booked for next week ready for my 15th appointment so I'll know more then

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