The advent of
prostate-specific antigen (PSA) testing and increased patient awareness has led to patients being diagnosed with
prostate cancer at an earlier stage and a younger age than previously. Adjuvant hormonal
therapy to
radiotherapy or
prostatectomy has been shown to reduce the risk of tumour progression, and in some studies survival benefits have been demonstrated. The non-steroidal
antiandrogen bicalutamide ('
Casodex') has undergone extensive evaluation and is currently undergoing clinical trials as immediate
therapy, either alone or as adjuvant to treatment of curative intent in patients with localized or locally advanced disease. Data from the first analysis of one of the studies in the Early
Prostate Cancer (
EPC) programme involving 3,603 patients have shown that, after a median follow-up of 2.6 years, the risk of
prostate cancer progression was significantly reduced (by 43%) in patients receiving
bicalutamide 150 mg compared with those receiving standard care alone (HR 0.57; 95% CI 0.48, 0.69; p << 0.0001). The risk of PSA progression was also significantly reduced (by 63%). At this stage the survival data are still immature. Side effects of
bicalutamide were mostly gynaecomastia and
breast pain, which is consistent with its pharmacology. Overall withdrawal rates were similar in the
bicalutamide 150 mg and standard care alone groups. In the
bicalutamide 150 mg group, withdrawals were mainly due to side effects, whereas in the group receiving standard care alone, withdrawals were mainly due to
disease progression. The programme is ongoing, and survival data are awaited.