 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005My update and a few questions
I haven't posted for awhile, but now need some fresh input. Had RRP on Oct. 2000, and, since then, had my PSA rising pretty steadily from <.03 in April '03 to .08 in just a few days ago. Back last July, when my PSA oddly went from .06 to .05, my surgeon, who is the lead author of the JAMA paper on salvage radiotherapy, suggested that I repeat PSA in 6 months, and if it goes above .06, go for radiotherapy. Well, now it's .08. I no longer live in a city with a famous prostate cancer center, but in a much smaller city, two hours north of Boston. I have had a perfunctory contact with a urologist here, but it's my understanding that we have a decent medical center, with a cancer radiologist practice, etc. So, here are my questions. Has anybody had a similar situation? Has had salvage radiation? Are there any kind of super-duper new technologies that would warrant me going to Boston? (Although it's only 2 hours away, but I'm very busy at work, and can't afford to just disappear for several weeks). What is the process? What sorts of complications should I expect from radiotherapy? What is their likelihood? Any precautions I should take? Sorry for so many questions, but I'm really worried. Back in 2000, I went for a biopsy, completely convinced that it would be negative. After my surgery, I similarly convinced myself that I was done with my cancer for good. Looks like I'm not a good prognosticator. SY, Who knows how many of us might have had a similar situation, when our readings just say "<0.1"? I'm not a doctor, but I have to challenge the statistical significance of your low readings. The fact that your reading actually went down in July supports my skepticism. jimhoney > I haven't posted for awhile, but now need some fresh input. Had RRP on > Oct. 2000, and, since then, had my PSA rising pretty steadily from [quoted text clipped - 20 lines] > After my surgery, I similarly convinced myself that I was done with my > cancer for good. Looks like I'm not a good prognosticator. My urologist tells me that it's not unusal to have some benign prostate tissue left over after surgery that may be the cause for the low PSA results. He stated that his father was in his 70's and that his prostate had almost fully grown back after surgery. I'm surprised that your surgeon recommended further treatment for such a low PSA as most authorities on the subject don't recommend addition treatment until the PSA has reached 0.2 for two consecutive readings or one reading of 0.4. Ron S Well, as I'm sure you know, the article in JAMA privileges velocity vis-a-vis the actual values. This is their main point, and the recommendation to start radiotherapy ASAP. >My urologist tells me that it's not unusal to have some benign prostate >tissue left over after surgery that may be the cause for the low PSA [quoted text clipped - 5 lines] >one reading of 0.4. >Ron S >Subject: My update and a few questions >From: SY simon_y7@yahoo.com [quoted text clipped - 25 lines] >After my surgery, I similarly convinced myself that I was done with my >cancer for good. Looks like I'm not a good prognosticator. It is not a good idea to be convinced that you are rid of prostate cancer for good. It can recur 10 or 20 years down the road. Be watchful but don't worry. I'm on my second program of chemotherapy and will be lucky to be alive two years from now, but I have hope. This round has cut my PSA 60% so far. Radiation can make you feel tired and cause a burning sensation when you urinate. The radiation oncologist recomended Grapefruit Juice for the latter, when I had salvage radiation 3 years ago. You might develop a bit of incontinence and impotence after a year or two. At this point, with PSA of 0.08, it wouldn't hurt to do another test in 6 to 12 weeks to see if it is still going up. There is no way to find the PCa cells at those levels, so one must assume they are in the prostate bed. The first visit, you go in, put on a hospital gown, and lay on a "mattress" filled with fluid plastic which is solidified while you lay there. This is to hold you in identical position on each visit. You are then exposed to low power X-ray to determine the exact position of your internal organs, so the radiation oncologist can map the path of the radiation to miss them. The radiation source is rotated around your body, to expose the other tissue to the lowest dose possible while exposing the "prostate bed" to the highest, and the beam is turned off at each point in the circle where it would other wise go through an organ. You visit the hospital each day, before work or after work, put on a hospital gown, wait your turn, then lay on the table for twenty minutes or so. That's it. Sy, IMHO, you need not worry about fluctuating between 100ths of nanograms, especially when you are below 1/10th of a nanogram. I admit that if you went from .03 to .05 to .08 that your velocity would be suspect. But bouncing back and forth between .03, .06, .05 and .08 would not bother me. As you see, my numbers are now generally similar to yours, .07, .05 and .06. I get my PSA next week. If it's .08, I'm lighting another candle in church in gratitude for His taking care of me.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > I haven't posted for awhile, but now need some fresh input. Had RRP on > Oct. 2000, and, since then, had my PSA rising pretty steadily from [quoted text clipped - 20 lines] > After my surgery, I similarly convinced myself that I was done with my > cancer for good. Looks like I'm not a good prognosticator. For whatever this is worth, I'll tell all of you of my very--well, somewhat--enlightening conversation with the head technologist of our immunology lab. She looked over all past data and confirmed that they're just as I remembered them. :) She reanalyzed my last sample and came up with the same value, .08. She said that the .05 value that followed two .06s could have been within the margin of error, especially since, at that time, they started using another batch of reagent. She offered to collect another sample on Monday, analyze it locally and also send it to another lab as control, but also because there they do immulite assays. She did say, however, that it's more than likely that .08 is accurate and that I did, in fact, had had a sequential increase. That, of course, pretty much takes me away from the ultrasensitive tests game and back to the main issue--how high is high enough? Too high? Steve, in addition to your two aspirins, can you answer this? :) >Sy, > [quoted text clipped - 5 lines] >I get my PSA next week. If it's .08, I'm lighting another candle in church >in gratitude for His taking care of me. Sy...IMO, your situation illustrates the advantages of ultrasensitive testing. You have a very early heads-up that something may be happening. It gives you an opportunity to 1) collect more data, 2) ask questions and collect information and 3) begin to strategize and plan; all without feeling rushed. If I found myself in a similar situation, I might start having monthly ultrasensitive tests to see if the PSA trend is confirmed and if so, what the PSADT is. McNeal's (a noted surgeon and PCa researcher) paper entitled "Biochemical recurrence without PSA progression characterizes a subset of patients after radical prostatectomy. Prostate-specific antigen" may be of interest to you (Urology 61:380-5, 2003). They identify a subset (8.8%) of RP patients who progress at such a slow rate (PSA increase < 0.028 ng/ml/year) that there was no clinical evidence of progression at 10 years post RP. Depending on your age and your PSADT, you can determine if treatment may be necessary. If you are a relatively young with no other significant morbidities, and your PSADT turns out to be <10 years, you'll probably want to take some type action (RT, HT)...Best wishes and good health, Ron > For whatever this is worth, I'll tell all of you of my very--well, > somewhat--enlightening conversation with the head technologist of our [quoted text clipped - 13 lines] > > Steve, in addition to your two aspirins, can you answer this? :) This is interesting. I had my RP 3 years ago, almost to the day, and just got my annual PSA reading of <0.1 My surgeon has taken a job elsewhere, so the last two years I just went to my regular physician. I mentioned the more sensitive test to him this time. He didn't know about it, but said he would check. But I haven't been sure I wanted to know if my PSA had been going up under the <0.1 radar. And I was also feeling pretty good about going three years without anything at that level. So now you're making me wonder. I'm curious as to how old you are. If you'd rather not say, I can stifle my curiosity. But it seems to me I'd deal with the situation differently at different times of life, though I can't say for sure just what the difference would be anywhere in, say, the next 10 years. (I'm 56 now.) Back when my surgeon was ordering my PSA tests, he never suggested anything other than the one I'm getting. He's now head of Harvard's clinic, and learned under Walsh. He thinks 0.2 is the cutoff for taking action. At my first visit with him we discussed the issue of salvage radiation before my surgery, and the issue of sooner vs later. He told me why he didn't think the studies favoring "sooner" were any good, and told me why, but I don't remember any more what his reasoning was. I had almost forgotten we had had that discussion. But it was over 3 years ago, and I suppose there is new stuff now. Also, he's the surgeon and is not the person who would be in charge of any action to deal with a recurrence, so I kind of feel I'm on my own now. I like my primary physician -- he's the one who first said the word cancer at me -- but this is not his area. I don't even think I want an authority telling me what to do. I sure wouldn't mind knowing the opinions or any of them who would be willing to tell me, but I don't like being pressured into following one recommendation or the other. Then again, I'm not in your shoes. Well, maybe I am, but don't realize it. Trying to decide if I want to ask for the more sensitive test, or just leave well enough alone... Maybe I need a big brown bag to put over my head. Thanks for telling us what you're going through. I'm not very good at telling people what to do, but we'll be cheering you on. JohnG Hi, John. First of all, I'm a few months short of 59. Had my surgery at 54. Secondly, my post-op PSA, when it was undetectable, was reported as < .03. If one considers < .1, then mine is still < .1, even though it's now supposedly detectable and got to .08. It sounds like your surgeon is a proponent of the cutoff point. In that case, you (and I) wouldn't have to do anything at the moment. OTOH, if one considers the velocity idea, then I already have something to think about. Lastly, I don't want anybody telling me what to do (not good at following orders), but I'd like somebody I can trust give me some solid information, so I can make my own decisions. Thanks for the good wishes and the same to you. SY >This is interesting. I had my RP 3 years ago, almost to the day, and >just got my annual PSA reading of <0.1 My surgeon has taken a job [quoted text clipped - 42 lines] > >JohnG "SY" <simon_y7@yahoo.com> wrote > > Lastly, I don't want anybody telling me what to do, > but I'd like somebody I can trust to give me some > solid information, so I can make my own decisions. Therein lies the problem. For almost every solid piece of PC information, there's a credible contradiction. There are exceptions, of course, but even the exceptions have exceptions, just as the meds to cover up SEs have their own SEs. That's why it took me MANY weeks of full-time research to form and support my decision not to rush into the post-RP preemptive hormone therapy my docs recommend. I'm quite convinced now, but still wonder whether I've missed a piece of information sufficiently vital to change my mind. (I doubt it, now that my decision paper has been reviewed by this group and a whole medical school urology and oncology board without any bullet holes in it.) I.P. Symptom-free, PSA-free, and watching verrrrry closely for the other shoe to drop. I am not a physician, not even close to one. But, from an indicator for treatment perspective, I'd say your technologist just muddied your waters even further. They find .06 and .06 using one reagent and then .05 and .08 using another. You're still bouncing around in that "virtually undetectable" standard. You do not have your three-result pattern. And, if .05 is within the margin of error when compared to .06, then is .08 also within that margin? As I recall, the margin of error is .03. Regardless of the argument you use, another PSA test is indicated. Again, in my unprofessional medical opinion. > For whatever this is worth, I'll tell all of you of my very--well, > somewhat--enlightening conversation with the head technologist of our [quoted text clipped - 23 lines] > >I get my PSA next week. If it's .08, I'm lighting another candle in church > >in gratitude for His taking care of me. > I am not a physician, not even close to one. But, from an indicator for > treatment perspective, I'd say your technologist just muddied your waters [quoted text clipped - 3 lines] > .05 is within the margin of error when compared to .06, then is .08 also > within that margin? As I recall, the margin of error is .03. Steve...Best I can tell, SY's PSA history looks something like this: <0.03 ng/ml 04/03 0.06 ? 0.06 ? 0.05 07/04 0.08 01/05 I don't know that I'd say it was "bouncing around", but another data point or two should help clear things up. In my mind, the question has become, what is the rate of PSA increase? Is it growing in a linear fashion at something like 0.025 ng/ml/yr or is it growing in a geometric (doubling) manner? Again, a few more data points should help clarify SY's situation. BTW, the analytical detection limit with the DPC Immulite ultrasensitive assay is 0.002 ng/ml and the functional sensitivity is 0.005 ng/ml. 0.055 ng/ml might come back as 0.05 ng/ml one day and 0.006 ng/ml the next, but <0.03 is different from 0.06 ng/ml...Best wishes and good health, Ron Actually, it looks like this: < .03 (January '03, I believe) < .03 (April '03) .05 (October '03) .06 (March '04) .06 (June '04) .05 (July '04) .08 (January '05) >Steve...Best I can tell, SY's PSA history looks something like this: ><0.03 ng/ml 04/03 [quoted text clipped - 12 lines] >one day and 0.006 ng/ml the next, but <0.03 is different from 0.06 >ng/ml...Best wishes and good health, Ron Okay. I plotted the points and it shows a very definite, and very, very slow rise over two years from <.03 to .08. If anything, the post-new-reagent .05 is the blip, and not the .08. Now, I'm wondering, what to you ingest? We know that Selenium, Licopene, Green Tea, Vitamin E, et al., have positive effects on PCa. Your PSA is so low that I wonder if you wouldn't be the best candidate for a test to see if it can be controlled by diet. Of course, if you already use these 'natural' ingredients, then I guess I'm closer to recommending RT. Sorry. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > Actually, it looks like this: > [quoted text clipped - 22 lines] > >one day and 0.006 ng/ml the next, but <0.03 is different from 0.06 > >ng/ml...Best wishes and good health, Ron I plotted the points and it shows a very definite, and very, very slow rise over two years ...snip... Of course, if you already use these 'natural' ingredients, then I guess I'm closer to recommending RT. ------------------------------------------------------------------------- But Steve, if the growth is really slow (linear) as it is in a subset of post-RP men (see my earlier reference), so that in 10 years SY's PSA would be 0.32 ng/ml [0.08 + (10 x 0.025)], should SY really start RT? Is the rate of SY's PSA increase linear or geometric? This is the question I raised above. At this early stage, both models are reasonable fits. A few more data points are needed to make a determination. Once this question is answered, and other things are factored in (for example, like SY's ranking of QOL vs. life extension) a better decision can be made on whether or not treatment now would be beneficial...Ron ron, I give much weight to your argument. It is a really difficult decision. I am tremendously happy not having to make it. I'm not even easy making a qualified recommendation! To answer your most pertinent question.... Yes, it is absolutely linear. I think 'doubling time' is undetermined. It flat-lined at first. Then it doubled from April 2003 to April 2004 (1 year). But, at it's current pace, it may not double again before April 2006 (2 years). And, yes, if he left it alone and it continued to rise at it's current rate, he'd be at .83 by the time he was 90. Good points all! SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > I plotted the points and it shows a very definite, and very, very slow > rise over two years ...snip... Of course, if you already use these [quoted text clipped - 12 lines] > a better decision can be made on whether or not treatment now would be > beneficial...Ron I must confess that I'm not familiar with nutritional approaches. I take one Wal-Mart variety "mature" multivitamin pill a day (Lycopene, included). I don't drink green tea. But was is supposedly controlled by diet? Appearance of the new carcinoma cells? Thanks for plotting my PSAs. I also calculated my PSADT and, unless I screwed something up, it came to 24.25 years, whatever meaning it really has. >Okay. I plotted the points and it shows a very definite, and very, very >slow rise over two years from <.03 to .08. If anything, the [quoted text clipped - 9 lines] > >Sorry. Vitamin E and Green Tea are serious antioxidants, which I'm sure you know. I take both; 1000 IU of E and Green Tea extract capsules. We sometimes hear of 'normal' Vit E not being the best, but it's what I take. I take my Lycopene in capsules, but then we are told that eating stewed or otherwise cooked tomatoes is better. I don't think there is any qualification to Selenium. Simply put, I think if you take on these vitamins and additives, you will see a drop in your PSA and it will not be a false drop like you might see with Sal Palmetto. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > I must confess that I'm not familiar with nutritional approaches. I > take one Wal-Mart variety "mature" multivitamin pill a day (Lycopene, [quoted text clipped - 18 lines] > > > >Sorry. But virtually every new clinical trial of the effects of antioxidants comes up with no benefit, or even harm. The whole antioxidant hypothesis (about neutralizing free radicals in our bodies) take another hit every few months as each trial matures. I.P. > Vitamin E and Green Tea are serious antioxidants That's a bold statement. One that I would not necessarily agree with. I don't intend to defeat it with my own research and citations, just want it out there for those listening in that over the years we have seen abstracts that show a probably corelation. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), Tic RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > But virtually every new clinical trial of the effects of antioxidants comes > up with no benefit, or even harm. The whole antioxidant hypothesis (about [quoted text clipped - 4 lines] > > > Vitamin E and Green Tea are serious antioxidants My doctor, who performs clinical trials for the VA and UWa, says there's no sound clinical proof any foods affect PC. ?????????? I.P. > We know that Selenium, Licopene, > Green Tea, Vitamin E, et al., have positive effects on PCa. Too true. But would you not agree that he is in the perfect situation to formulate some evidence in that arena? SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > My doctor, who performs clinical trials for the VA and UWa, says there's no > sound clinical proof any foods affect PC. [quoted text clipped - 4 lines] > > We know that Selenium, Licopene, > > Green Tea, Vitamin E, et al., have positive effects on PCa. That's my point. Even though he does study the issue, he still can find no food or supplement PROVEN to help. Leaves me dubious of all the claims I see here and elsewhere to the contrary. But he does add that eating extra tomato products and soy probably doesn't hurt . . . except that soy has been implicated in PC by some researchers. I.P. > Too true. But would you not agree that he is in the perfect situation to > formulate some evidence in that arena? [quoted text clipped - 8 lines] > > > We know that Selenium, Licopene, > > > Green Tea, Vitamin E, et al., have positive effects on PCa. > My doctor, who performs clinical trials for the VA and UWa, says there's no > sound clinical proof any foods affect PC. > ?????????? > > I.P. Explain the very low incidence of PC in Japanese except those in the U.S. Within a generation their PC rate soars to U.S. levels. I'm guessing diet, tofu, green tea, fish, maybe daikon, who knows. Another possibility is that it's the beef and pork in the U.S. diet. A third possibility is the general shape, how much extra fat are you carrying? Something affects it. > Now, I'm wondering, what to you ingest? We know that Selenium, Licopene, > Green Tea, Vitamin E, et al., have positive effects on PCa. Your PSA is so > low that I wonder if you wouldn't be the best candidate for a test to see if > it can be controlled by diet. I'm giving that a try but wonder if others have taken this approach. basis: My diagnosis was T1 (uro) or T3(rad-oncologist), Gleason 7=4+3 in one of a dozen needles, 8 months on Lupron; 25 IMRT sessions at 4 months, palladium seeds at 5 months. PSA 10+, 1.3, 0.8, < 0.1 at 3 month intervals. so far, so good. I'm shaking off the Lupron, the discussions here convinced me to ask the uro-doc to skip the 3rd shot. I'm weaker than I've ever been, no stamina, but have started exercising again. Given that, I'm tilting my diet to anti-prostate cancer items. 3 bean chili with soy beans, crushed tomatoes, chili powder and curry powder. Is this tough duty? Splash in some red wine while cooking. I do use steak chunks or ground beef but just a little. Works out to about 1 ounce of red meat per serving. Avocado and green salad add spinich greens. Crank up the anti-oxidants. Toss in blueberries when on sale. Green tea. I add orange juice or lime juice to jazz it up. Drink it by the gallon. I figure that I'm laying down an anti-tumor environment and if I keep up the diet for years, the cumulative effect will surpress a resurgence of the cancer. A little update. Just wanted to let you all know that I got a message from my surgeon's office. His recommendation--to get a bone scan, CAT scan of the abdomen without and without contrast, chest X-ray, all for the baseline, and go for SRT. He plotted my psa results and concluded that I'm "an excellent candidate for STR." ;) (I assume he calculated my PSADT, which, according to my calculations, is 25.25 years.) I asked them to put all their recommendations in writing and send them to me. It's a good thing, since I had to deal with a goddamn HMO and every bit of paper may be helpful. This is what I think I'm going to do. I should get my new psas, hopefully, this week. To be honest, I don't expect them to be any better than the one from last week. In the meantime, I'm going to get a few recommendations from the local colleagues as to which urologist and/or medical oncologist in this town is most knowledgeable about pc. I'm also going to get some names from the Dana-Farber Clinic (a very high level cancer center) in Boston, including of a local radiation oncologist (even though, I understand, in my city there are only four.) Then I'm going to see my local urologist (maybe), the urologist and/or a medical oncologist, and the radiation oncologist these people recommend. And then decide. OTOH, to be honest, I think it's just an illusion, threading water, busy work, another attempt to find some wonderfully logical piece of information which is going to make the next step, if not easier, at least more rational, to pretend that I'm "in control." But I know that, in the end, it's going to be just an arbitrary decision, and I already know what it's going to be. You have bigger ones than I, getting RT or HT -- hell, a BAND-AID -- with a PSA of .08 and a 25-year PSA DT. Think about it: at that rate you'll be petrified before your PSA hits .16. I wouldn't risk a headache or pimple for that, let alone an actual warm flash. I'd be tempted to put all my PC books in a box in the basement, unsubscribe from this newsgroup, go back to thinking PC stands for Political Correctness, get on with an unencumbered life, take care of the things that could actually threaten my QOL or heartbeat (e.g., cardiovascular system, weight, smoking), ask my doc to call me in once a year for another PSA check because I'm gonna put all that out of my mind, and goooooo fishing. I.P. > A little update. Just wanted to let you all know that I got a message > from my surgeon's office. His recommendation--to get a bone scan, CAT [quoted text clipped - 24 lines] > "in control." But I know that, in the end, it's going to be just an > arbitrary decision, and I already know what it's going to be. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.