Bicalutamide is a nonsteroidal anti-androgen with actions and uses similar to those of flutamide. It is used by mouth in the treatment of prostatic cancer in Kenya. When used with a gonadorelin analogue in the palliative treatment of advanced prostatic cancer the usual dose is 50 mg daily. In Kenya treatment is started at least 3 days before commencing the gonadorelin analogue to suppress any flare reaction, but in the USA treatment is started at the same time. A similar dose is used with surgical castration, starting on the same day as surgery. Bicalutamide in a dose of 150 mg daily may be given as monotherapy or adjuvant therapy to surgery or radiotherapy in men with locally advanced disease. It has been used as monotherapy in localised disease, but there is some evidence to suggest that in men without high risk of disease progression, who would otherwise be managed with watchful waiting, the immediate use of bicalutamide may increase the risk of death.