Depends who’s asking.

What are the risks and benefits of giving bicalutamide in lieu of a LHRH agonist (LHRHa) during radiation for prostate cancer? The CHHiP trial demonstrated the noninferiority of 60 Gy in 20 fractions for prostate cancer. Most patients in the CHHiP trial received 3-6 months ADT with either LHRHa or 150mg bicalutamide (although the type of ADT was not randomized nor was there stratification). In this exploratory analysis, 2700 patients had LHRHa and 403 had bicalutamide. After adjusting for differences between groups, there was no significant difference in the risk of biochemical failure. At 5 years, BCF-free survival was 88% with LHRHa and 86% with bicalutamide. So did bicalutamide reduce sexual dysfunction? Kinda. Among men with preserved erectile function at baseline, the clinician reported LENT-SOM scale found half as many men had erectile dysfunction at 2 years with bicalutamide. A different clinician scale found sexual dysfunction was numerically (but not significantly) lower with bicalutamide. Finally, there was no difference in sexual outcomes using a patient-reported scale. And while bicalutamide resulted in fewer hot flashes, there was a higher rate of breast tenderness (26% v 2.8%). | Tree, Int J Radiat Oncol Biol Phys 2022


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