Editing Hormonal Therapy (section)

====== First-generation (flutamide, bicalutamide, nilutamide) ======
* '''MOA: acts by binding to the AR in a competitive fashion'''
* '''Flutamide'''
** '''Short half-life,''' '''three times per day dosing'''
* '''Bicalutamide'''
** '''Long half-life''', once per day dosing
** '''Pharmacokinetics are not affected by age, renal insufficiency, or moderate hepatic impairment'''
** '''Associated with maintenance of serum testosterone levels in the majority of patients'''
** '''150 mg/day bicalutamide monotherapy appears to have equivalent efficacy to medical or surgical castration in men with metastatic or locally advanced disease.'''
*** Bicalutamide monotherapy (150 mg/day) is also associated with significantly better quality of life in the domains of sexual interest and physical capacity compared to surgical castration. There are, however''', higher rates of gynecomastia (66.2%) and breast pain (72.8%)'''
* '''Nilutamide'''
** About 1/4 men on nilutamide therapy will note a '''delayed adaptation to darkness after exposure to bright illumination'''