In an online article published Friday, November 6, 2015 Dr. David Crawford raises some very serious questions about how we standardly use hormone therapy (ADT) in the treatment of men with advanced prostate cancer. He claimed that not only is it vital for initial positive outcomes, it is vital for the successful use of the new, second line ADT treatments (Zytiga, Xtandi) to achieve castration levels that are as low as possible, at least less than 20 ng/dL.

He cited evidence that men treated with hormone-based therapies for androgen-sensitive prostate cancer (ADT) have better outcomes when they achieve testosterone levels less than 7 ng/dL—significantly lower than the 50 ng/dL that the FDA recognizes as a castration threshold. Dr. Crawford’s comments were made in a presentation at the 2015 Large Urology Group Practice Association (LUGPA) Annual Meeting.

“Prostate cancer is a hormonally dependent cancer and we need to understand that. The goal is to lower or block androgens, and the lower the better. Get the level as low as you can and keep it as low as possible,” said Crawford, who is head of Urologic Oncology at the University of Colorado. Dr. Crawford cited a number of studies that showed that there is a two-fold difference in risk of death between men with testosterone levels less than 20 ng/dL and those with levels greater than 50 ng/dL.

Currently the FDA sti