Friday, May 6, 2011

Combining Hormonal Therapy With Radiation To Treat Prostate Cancer: Who Needs It And For How Long?

A question that I have repeatedly heard from readers has been about the length of time hormonal therapy needs to be given in conjunction with radiation to treat prostate cancer.  As I replied to these readers, the answer, like most aspects of prostate cancer treatment, is not very straightforward and remains somewhat controversial.  In this post I will attempt to clarify which men actually need hormonal therapy in addition to radiation, the benefits of this additional hormonal therapy, and the ideal duration of the therapy.

Why Add Hormones to Radiation Therapy?

The benefits of adding hormones to radiation therapy for prostate cancer were first demonstrated through animal experiments.  These studies evaluated the added efficacy of androgen deprivation (hormonal therapy) when combined with radiation therapy in treating prostate tumors in mice.  The studies scientifically demonstrated that the hormonal therapy reduced the amount of radiation necessary to destroy and control the growth of the tumors.  These and other studies have proposed that radiation and hormonal therapy work synergistically to destroy prostate cancer cells and keep them from spreading locally and into the bloodstream. 

The added benefits of hormonal therapy were then tested in the clinical setting on real patients.  One of the seminal studies testing the theory was conducted in Europe over a decade ago. The study compared the outcomes of men with locally advanced prostate cancer who underwent either radiation therapy alone or radiation therapy combined with a 36 month course of hormonal therapy.  The study demonstrated that, 10 years after treatment,  men undergoing combination therapy enjoyed superior overall survival (58% vs 39%) and a much lower chance of dying specifically from prostate cancer ( 11% vs 31%) when compared with those men undergoing radiation alone.  Studies such as this ushered in the wave of hormonal therapy that has been becoming more and more popular in the treatment of localized prostate cancer.     

As more and more patients were placed on hormonal therapy, it soon became apparent that this additional treatment does not represent a free lunch.  As I described in my previous post, hormonal therapy comes with significant risks to your heart while increasing your chance of developing diabetes.  In addition, hot flashes and sexual dysfunction can have a dramatic impact on quality of life for men on the therapy.  As such, many began to wonder if 3 years of hormonal therapy is really worth the benefits.  Studies have been conducted comparing the combination of radiation plus short term hormonal therapy (4-6 months) with radiation alone.  One such study demonstrated a superior 8 year overall survival for men undergoing the combination therapy (74% vs 61%) as compared to men undergoing radiation therapy alone.  The presence of this new data subsequently begged the question of whether long term hormonal therapy yielded any benefits above and beyond those achieved with short term hormonal therapy.  Excellent, randomized studies were conducted to answer just this question. 

Optimal Duration of Hormonal Therapy

Two large, randomized trials have been carried out comparing short term with long term hormonal therapy in combination with radiation therapy.  These studies were carried out specifically in men with HIGH RISK prostate cancer.  Only men with either locally advanced prostate cancer (T2c-T4) or positive lymph nodes were evaluated.  I emphasize this point because, as I shall explain later, the results and conclusions can not and should not be applied to treatment decisions for ALL men with prostate cancer. 

The first trial, known as Radiation Therapy Oncology Group 92-02 studied over 1500 men with T2c-T4 prostate cancer (cancer which took over both lobes of the prostate and/or extended out of the prostate to varying extents) with or without positive lymph nodes.  Men in the study were randomly enrolled into one of two treatment protocols:
1)      Radiation plus 4 months of hormonal therapy (starting 2 months prior to radiation)
2)      Radiation plus 28 months of hormonal therapy(starting 2 months prior to radiation)

The study demonstrated that, after 10 years, men undergoing long term hormonal  therapy enjoyed better cancer specific survival (89% vs 84%), lower chance of metastatic disease (15% vs 29%), and a lower chance of further local spread ( 12% vs 22%) than those undergoing short term hormonal therapy .  What the study did not demonstrate, however, was a significantly improved overall survival rate for men undergoing the long term versus the short term hormonal therapy.  The study then analyzed a particularly high risk subset of men with Gleason 8-10 prostate cancer.  In this subset of patients, in contrast, a significantly superior overall survival rate (45% vs 32%) was seen in men undergoing long term hormonal therapy.

The second study was conducted by the European Organization for Research and Treatment of Cancer.  This trial evaluated 970 men with either locally advanced prostate cancer (T2c to T4) or men with positive lymph nodes and any local stage.  The study divided the patients randomly into two treatment groups:
1)      Radiation therapy plus 6 months of hormonal therapy (starting the first day of radiation).
2)      Radiation therapy plus 36 months of hormonal therapy (starting the first day of radiation).

After about 6 years of follow up, the study demonstrated a small but significant overall survival advantage for men on long term versus short term hormonal therapy (85% vs 81%).  The difference in death rates (19% vs 15%) represented a 42% higher chance of death for men undergoing short term versus long term hormonal therapy. 

While demonstrating slightly different impacts, both studies concluded that men with HIGH RISK prostate cancer should be considered for long term hormonal therapy.


Long Term Hormonal Therapy: Who Really Needs It?
While the above mentioned studies argue for adding long term hormonal therapy to radiation for treatment of HIGH RISK prostate cancer, they DO NOT conclude that all men undergoing radiation therapy for prostate cancer need hormonal therapy.  Before discussing the suggested regimens for men without high risk disease, we should review the accepted “risk” categories for prostate cancer:

1)      High Risk: Prostate cancer that is locally advanced (T2C-T4) and/or Gleason score 8-10 and/or associated with a PSA greater than 20
2)      Intermediate Risk: Prostate cancer with moderate local stage (T2b) and/or Gleason score 7 and/or PSA 10-20.
3)      Low Risk: Prostate cancer with low local stage (T1b-T2a) and Gleason score 2-6 and PSA less than 10.

These risk categories are very important to understand, particularly in context of prostate cancer studies.  In relation to adding hormonal therapy to radiation for prostate cancer, the utility of the additional hormonal therapy depends on what risk group you are looking at.  As I mentioned above, the added benefits of hormonal therapy, particularly long term hormonal therapy were demonstrated only in HIGH RISK prostate cancer patients.  In contrast, no study has ever demonstrated any benefit of adding hormonal therapy to radiation of LOW RISK prostate cancer.  The data for INTERMEDIATE RISK is more mixed.  While no studies have specifically evaluated the added benefit of combining hormonal therapy with radiation therapy for INTERMEDIATE RISK prostate cancer, numerous patients with INTERMEDIATE RISK disease were included in the studies evaluating HIGH RISK patients.  These studies did demonstrate a benefit of adding hormonal therapy to a radiation therapy regimen for patients with INTERMEDIATE RISK disease.  No study, however, has demonstrated any significant additional benefit of long term over short term hormonal therapy for INTERMEDIATE RISK disease.  As a result, many of the radiation oncologists performing these studies recommend a combination of short term hormonal therapy and radiation for men with INTERMEDIATE RISK prostate cancer.  This recommendation, of course, is only valid  if the risks of the additional hormonal therapy (heart risk, diabetes, osteoporosis) do not outweigh the benefits for a given patient.  In addition, because no randomized studies have been carried out looking to answer this question in men with INTERMEDIATE RISK disease, the data and recommendations I have just mentioned for INTERMEDIATE RISK disease can be considered fairly trustworthy but not definitive.

Take Home Message

The controversy over the optimal duration of hormonal therapy to give in combination with radiation for prostate cancer again demonstrates the recurrent theme we hear about repeatedly in relation to prostate cancer therapy: prostate cancer treatment cannot be carried out with a “one size fits all” approach.  While studies seem to demonstrate a modest although significant advantage to long term ( > 2 years) hormonal therapy in addition to radiation for HIGH RISK prostate cancer, there has been NO evidence demonstrating that hormonal therapy for LOW RISK prostate cancer is of any benefit at all.  INTERMEDIATE RISK prostate cancer, in turn, may be optimally managed with a combination of radiation and short term hormonal therapy although we still await definitive studies to confirm this.  In addition, even when keeping these risk groups in mind, the final decision of whether or not to add hormonal therapy to radiation (and, if so, for how long ) really rests on weighing the risks and benefits for each individual patient. In some men with HIGH RISK prostate cancer, cardiac and metabolic risk factors may make the risks of heart attack and diabetes posed by hormonal therapy far outweigh the benefits of the treatment.  In contrast, some otherwise healthy men with HIGH RISK prostate cancer may derive significant benefits from the additional hormone therapy with minimal additional risks.  The key to answering this question is to really understand your situation.  Make sure that you understand your particular prostate cancer risk group.  Also, make sure that you discuss your cardiac and metabolic risk factors with both your urologist/radiation oncologist and your primary doctor (who is more familiar with your overall health).  Finally, make sure that your doctor weighs these competing factors with you so that you can be assured that, no matter what your given situation, the treatment course you chose truly provides you with more benefits than risks.


Check out my new Book: 

30 comments:

  1. Thank You VERY much for this great analysis of the radiation plus HT treatment protocol..

    ReplyDelete
    Replies
    1. i was diagnosed with HIV/AIDS for over 5 years which made loose my job and my relationship with my fiance after he discovered that i was having HIV, he departed from me i tried all my best to make him stays with me, but neglected me until a friend of mine on Facebook from Singapore told me Great healer, who will restore my life back with his powerful healing herbs... he sent me the email address to contact (draribaspelltemple@gmail.com) and i quickly contacted him, and he said my condition can solved, that he will treat the disease immediately only if i can accept trust him and accept his terms and condition, i Agreed because i was so much in need of help by all means, so i did all he want from me and surprisingly on Sunday last week He sent me a text, that i should hurry up to the hospital for a checkup, which i truly did, i confirm from my doctor that i am now ( HIV NEGATIVE) my eyes filled with tears and joy, crying heavily because truly the disease deprived me of many things from my life, This is a Miracle, Please do not en-devour to email dr.aribaspelltemple@outlook.com, or draribaspelltemple@gmail.com or call 2348140439497 for healing and solution

      Delete
    2. Appreciation is the key to doing more that is why I have took some time out to thank some one who cured me of my 2 years HEPATITIS B problem. It became a major problem to me as it was affecting my marital life and I was no longer comfortable so I decided to look for a solution and I came across a post of Dr Ariba and how he has been helping people of the same problem I contacted him and told him all I have been facing in my life. He told me how to get his product and how to take it after every thing I find out that all was now okay with me and that my HEPATITIS B problem was gone that is why I have come out today to say thank you to him . if you need cure for HIV/AIDS, Herpes, cancer or diabetes of all types you can contact his email draribaspelltemple@gmail.com OR dr.aribaspelltemple@outlook.com
      Whatsapp: +2348140439497

      Delete
    3. Dr MABUWA is a great healer that can heal your disease. i was cured from HSV 1 and HSV 2 VIRUS after i contacted from my boyfriend after he cheated and since 2years ago i had been living a life full of fear. but when i surfed on the internet one morning and i saw comment on Dr MABUWA curing deadly disease. HERPES.HIV.DIABETES.HPV.HBV. CANCER and many more. i was skeptical that he might not be real then i decided to give a try to him. and as i did i never regretted contacting the great Dr MABUWA. he told me the ways and how to get my herbal medicine i believe and worked with him and he sent me my herbal medicine and as i received it he gave me instruction on how i will take it and i also gave my boyfriend to also drink because i really love him. despite he cheated on me. and behold Dr MABUWA said after 2weeks of usage we should go for test and as we did. our result both came out negative. Many lives has been saves because of you sir. may you ever reign and may God bless you more. you can reach him on his Email:drmabuwasolutioncuretemple@gmail.com or his What app Mobil:+2348130714541 or visit his Webs:https://drmabuwasolutioncu.wixsite.com/drmabuwa

      Delete
  2. I'm so glad I found this blog. (you put a link on Huffington Post, 5/18/11. My husband was diagnosed in October 2004. He had radical prostate surgery in December 2004. His cancer was outside the prostate and into the neck of the bladder. He was considered a Gleason score 9 or 10, PSA was 16.9 and he was T4. The cancer also went into his tailbone, lymph nodes were clear. He received his first Lupron shot in February 2005 and 7 weeks of radiation in April through May 2005. He has received a shot of Lupron every 4 months since. He's tried to go every 6 months between shots but each time his testosterone rebounds to 178 or 179 and his PSA, normally 0.023, goes up to 0.l. He just tried the 6 month wait. I worry about him becoming hormone refractory but don't want to risk having his cancer active. Your thoughts about long term lupron therapy?

    ReplyDelete
  3. Fairwind: Thanks so much for the positive feedback.

    ReplyDelete
  4. Joy: I am glad that you find the blog useful. As for long term lupron therapy, it definitely has its risks but these risks usually manifest themselves within the first year or 2 of treatment rather than chronic use. In addition, the risk of recurrent or growing cancer during periods of subtherapeutic testosterone levels( usually greater than 50) is substantial. As a result, most urologists do no recommend extending the periods between injections for men with high risk disease if the testosterone level immediately springs back after 3 or 4 months.

    ReplyDelete
    Replies
    1. Dr MABUWA is a great healer that can heal your disease. i was cured from HSV 1 and HSV 2 VIRUS after i contacted from my boyfriend after he cheated and since 2years ago i had been living a life full of fear. but when i surfed on the internet one morning and i saw comment on Dr MABUWA curing deadly disease. HERPES.HIV.DIABETES.HPV.HBV. CANCER and many more. i was skeptical that he might not be real then i decided to give a try to him. and as i did i never regretted contacting the great Dr MABUWA. he told me the ways and how to get my herbal medicine i believe and worked with him and he sent me my herbal medicine and as i received it he gave me instruction on how i will take it and i also gave my boyfriend to also drink because i really love him. despite he cheated on me. and behold Dr MABUWA said after 2weeks of usage we should go for test and as we did. our result both came out negative. Many lives has been saves because of you sir. may you ever reign and may God bless you more. you can reach him on his Email:drmabuwasolutioncuretemple@gmail.com or his What app Mobil:+2348130714541 or visit his Webs:https://drmabuwasolutioncu.wixsite.com/drmabuwa

      Delete
  5. I tested on gleason score of 7, took one shot of lupron and then had 40 days or radiation....my urologist wants to inject me for 2 years of lupron and I am going off of it....Because of arthritus I do not think that lupron is good for me....I also think my heart beat has risen....what do you think?

    ReplyDelete
  6. randy: While I cannot comment on specific situations or give specific advice I can tell you that hormonal therapy, indeed, is not a free lunch and has side effects, particularly on the heart. I dedicated a previous post to this subject that you may find useful. These side effects need to be weighed against the potential benefits in terms of cancer control. The decision needs to be made while keeping your cancer extent AND your overall health in mind. You should consider discussing these concerns with your urologist.

    ReplyDelete
  7. Hormonal therapy is really effective and it is really useful for prostate cancer treatment.

    Prostate Cancer Treatment

    ReplyDelete
  8. hello to you all, my name is Wendy Brimm , i am from Vegas here in united state, i wish to tell you all, how i find a doctor that cure me from SKIN CANCER, which i had for three years with his natural herbal medicine he gave to me , it all went this way, i was internet that very day when i saw a comment of a woman called MARIA KATRINA from united kingdom sharing her testimony about how this very doctor cured her of HIV, and he also cured AIDS too, but i never really believed but i just decided to give it a try and i contacted DOCTOR HAKIM, so he told me everything i needed to know and what to do to get cured and free from my cancer issue, so i went straight and make provisions for the herbs which he used to prepare medicine for me,i applied the medicine and just to see that the exact day which doctor harkim said i we be cured i was felling good and healthy at once, my strength was regained i went for check up in the hospital and my family doctor told me i am free from cancer my skin can back to normal, this was the greatest miracle that has happened to me in my life, and i promise doctor hakim that i we share his good work to the world, these are few i can say about this DOCTOR HAKIM, i went with my family to thank him for his great work and solution in my life, wish i never expected this was possible, I we like you to contact him ADDRESS:dr.hakimherbalspellworld@gmail.com if you have any health issue i believe this doctor can help you out as well.

    ReplyDelete
  9. Hello Everyone, my names is Brown, i m from Florida USA. I want to share my testimonies to the general public on how this great man called Dr fadeyi cure my cancer. I have been a cancer patient for over 3 years and i have been in pains until i came across this lady when i traveled to Africa for Business trip who happen to once been a cancer patient, i explain every thing to her and she told me that there is this Great Dr that help her to cure her cancer and she gave me his email address for me to contact and i did as she instructed. And the man Dr fadeyi told me how much to buy the Cancer herbal medication and how i will get it which i did and to my greatest surprise that i took the Cancer herbal medicine for just one week and behold i went for a cancer test, for to my greatest surprise for the Doctor confirmed me to cancer free and said that i no longer have cancer in my system and till now i have never felt any pains nor cancer again, so i said i must testify the goodness of this man to the general public for if you are there surfing from this cancer problems or any deadly disease or other disease for i will advice you to contact him on his working email: doctorfadeyitempleofspell@gmail.com and i assure you that he will help you just as he did for me okay

    contact him on his email: doctorfadeyitempleofspell@gmail.com or you can as well contact his mobile line on +2348109468820



    ReplyDelete
  10. There lots of studies that proved that hormone replacement therapy is really useful for prostate cancer. Of all articles that I had read, this is the only article that is discussing the combination of hormone replacement therapy with radiation therapy. Very Useful.

    ReplyDelete
  11. Am Jessica Morgan,i have read testimonies about this great man called Dr.Ekpiku how he helped people to get pregnant and also help people to cure Herpes simplex virus with his herbal medicine, so i decided to give him a try, i am here today to give my own testimony on how this great man helped me to cure my Herpes disease and also helped my sister to get pregnant, i just told him and he said he was going to work on it miraculously and in a short period of time i was lifted from these terrible disease. And it took my sister just a week to get pregnant after he was done. Contact this great man and He will help you no matter the problem you are facing. Email him at ekpikuspelhomeofgrace@gmail.com or ekpikuspelhomeofgrace@hotmail.com call +2348073673757 OR whatsapp him.THESE ARE THE THINGS Dr. Ekpiku. . HERPES . HIV/AIDS . CANCER

    ReplyDelete
  12. We sell a wide range of kush strains like *Purple Kush,Blue dream,White widow,Skunk,Afghan kush,Blueberry,Og kush*Sour Diesel, *Green Crack, *Jack Herer, *Blue Dream, *Hindu Kush *,White Widow, *Real OG, *Hawaii-Skunk *Super Silver Haze *Blueberry *Super Skunk *AK-47 and many more strains in stock.we also have cannabis oils like Cannabis Butane,Hash Oil,Butter/Oil,Budder/Earwax/Honeycomb/Super Melt,Wax/Hash Oil,ISO Hash/QWISO,Bubble Hash/Full Melt/Ice Wax,Shatter/Amberglass/Sexy Oil,Kief/Dry Sieve ,Scissor/Finger Hash,Alcohol and Glycerine Tinctures,honey oil and many more Fast and discreet delivery . contact us at christinajacobs932@gmail.com or text (234) 650-7490
    ************

    ReplyDelete
  13. High Quality marijuana Blueberry Kush, Super Skunk, sour diesel, White Widow Purple Cream, Blue sky, Deep Purple to name a few. We guarantee that all our products are of high quality. Orange Krush, Blueberry bud, Dutch Haze herbal smoke purple kush O.g kush Bubble gum or Jamican Arabic solid smoke Blonde honey dream smoke skunk Panama gold Kanzak smoke smoke island Mystical Spirit Smoke King Tut Herbal Smoking Blend Wild Greens Herbal Smoke Blueberry Haze purple haze grandfather Sour diesel White Widow purple Max super med lavender Kush headband mango Kryptonite Purple Kush Ballsack Mango Kush Kandy Kush Soul Assassin OG Sandman, ReCon, Blue Dream, Snow Wreck, Pineapple Express, Purple Kush, Big King Bud, *Green Crack: Grade: AA *sour Diesel ::Grade: A+ Top Shelf *Grand Daddy Purple ::::Grade: A *Sensi Star x ak47 :Grade: AAA *Afghan Kush :Grade: A *Northe Lights #5 Grade: A+ *Lemon drop:::Grade: A+ *Purple Kush:::::Grade:A+ Top Shelf *OG Kush ::::Grade:A++ Top Shelf *purple-urkle::Grade: A- Plus Many More! We deliver “high grade”, low prices negotiable prices and discreet delivery to any location. contact via (234) 650-7490
    christinajacobs932@gmail.com !!!!!!!!!!!


    ReplyDelete
  14. i was diagnosed with HIV/AIDS for over 5 years which made loose my job and my relationship with my fiance after he discovered that i was having HIV, he departed from me i tried all my best to make him stays with me, but neglected me until a friend of mine on Facebook from Singapore told me Great healer, who will restore my life back with his powerful healing herbs... he sent me the email address to contact (draribaspelltemple@gmail.com) and i quickly contacted him, and he said my condition can solved, that he will treat the disease immediately only if i can accept trust him and accept his terms and condition, i Agreed because i was so much in need of help by all means, so i did all he want from me and surprisingly on Sunday last week He sent me a text, that i should hurry up to the hospital for a checkup, which i truly did, i confirm from my doctor that i am now ( HIV NEGATIVE) my eyes filled with tears and joy, crying heavily because truly the disease deprived me of many things from my life, This is a Miracle, Please do not en-devour to email dr.aribaspelltemple@outlook.com, or draribaspelltemple@gmail.com or call 2348140439497 for healing and solution

    ReplyDelete
  15. We have Quality Cannabis oil and medical marijuana for cancer cure, insomnia, back pain, to reduce stress and other illness.
    We are selling our products at very negotiable and workable prices. Apart from our very magnificent prices, when you buy from us, you are assured of the highest quality and purity available in the market, with a guaranteed discreet courier shipping or a special 24 hours confidential overnight delivery of the product to your address. We respect and value your privacy and will not share your information with anyone.
    We offer discreet and Reliable packaging and delivery. -Fast and reliable shipment within 24hours within the US and 48 hours internationally, using courier service , email:neistachemical@gmail.com
    website:neistachemical.cabanova.com
    skype:neista.chris
    text or call:+1(971)2366955

    ReplyDelete
  16. Hi Friends i am so glad to write this article today to tell the world how Dr Ekpiku cured my HSV VIRUS,i have been detected with HSV-1 AND HSV-2 since five years ago, ever since then my life has been in complete bizarre and agony,i have used so many drugs that was prescribed to me by several doctors,but it didn't cure my HSV VIRUS neither did it reduce the pain,until a certain i was checking for solution in the internet,then miraculously came across Dr Ekpiku the powerful herbalist that cure numerous individuals HSV-1 AND HSV-2 INFECTION,then i contacted his email: ekpikuspellhomeofgrace@gmail.com i explained everything to him and prepared a cure that cure my HSV-1 AND HSV-2 disease totally after receiving his herbal medicine, so my friends viewers why wait and be suffer when there is someone like Dr Ekpiku that can cure any disease HIV/ CANCER/ HEPATITIS B VIRUS, you can contact his via: ekpikuspellhomeofgrace@hotmail.com or whatapps, call +2348073673757.

    ReplyDelete
  17. Appreciation is the key to doing more that is why I have took some time out to thank some one who cured me of my 2 years HEPATITIS B problem. It became a major problem to me as it was affecting my marital life and I was no longer comfortable so I decided to look for a solution and I came across a post of Dr Ariba and how he has been helping people of the same problem I contacted him and told him all I have been facing in my life. He told me how to get his product and how to take it after every thing I find out that all was now okay with me and that my HEPATITIS B problem was gone that is why I have come out today to say thank you to him . if you need cure for HIV/AIDS, Herpes, cancer or diabetes of all types you can contact his email draribaspelltemple@gmail.com OR dr.aribaspelltemple@outlook.com
    Whatsapp: +2348140439497

    ReplyDelete

  18. Apply for real register Passport ,Visa,Driving License,ID CARDS,marriage certificates,diplomas etc for sell Guaranteed 24 hour passport,citizenship,Id cards,driver license,diplomas,degrees,certificates service available. Tourist and business visa services available to residents of all 50 states and all nationalities Worldwide. are unique producers of Authentic High Quality passports, Real Genuine Data Base Registered and unregistered Passports and other Citizenship documents.I can guarantee you a new Identity starting from a clean new genuine Birth Certificate, ID card, Drivers License,Passports, Social security card with SSN, credit files, and credit cards, school diplomas, school degrees all in an entirely new name issued and registered in the government database system.. We use high quality equipment and materials to produce authentic and counterfeit documents.All secret features of real passports are carefully duplicated for our Registered and unregistered documents.we are unique producer of quality false and Real documents.We offer only original high-quality Registered and unregistered passports, driver´s licenses, ID cards, stamps, Visa, school Diplomas and other products for a number of countries like:USA, Australia, Belgium,Brazil, Canada, Italian,Finland, France, Germany, Israel, Mexico, Netherlands, South Africa,Spain, United Kingdom. contact us or call us contact us for your cheap passport ,driving license, idcards,fakesid with ultraviolate light rays have holograms, scannable noveltyIDs ids Id contact us via fakelegitids@gmail.com or text (630) 909-3056

    ReplyDelete
  19. BUY PASSPORTS,DRIVERS LICENSES,ID CARDS,BIRTH CERTIFICATES,VISAS,SSN,MARRIAGE CERTIFICATES,DIVORCE PAPERS,US GREEN CARD,IELTS,IELTS & TOEFL, ESOL ,GRE,GMAT ((( documentswithcom@gmail.com )))

    Apply for real register Passport ,Visa,Driving License,ID CARDS,marriage certificates,diplomas,IELTS,IELTS & TOEFL, ESOL ,GRE,GMAT etc for sell Guaranteed 24 hour passport, citizenship, Id cards, driver license, diplomas,degrees,certificates,IELTS,IELTS & TOEFL, ESOL GRE,GMAT service available. Tourist and business visa services available to residents of all 50 states and all nationalities Worldwide. are unique producers of Authentic High Quality passports, Real Genuine Data Base Registered and unregistered Passports and other Citizenship documents.I can guarantee you a new Identity starting from a clean new genuine Birth Certificate, ID card, Drivers License,Passports, Social security card with SSN, credit files, and credit cards, school diplomas, school degrees,IELTS,IELTS & TOEFL, ESOL GRE,GMAT all in an entirely new name issued and registered in the government database system.. We use high quality equipment and materials to produce authentic and counterfeit documents.All secret features of real passports are carefully duplicated for our Registered and unregistered documents.we are unique producer of quality false and Real documents.We offer only original high-quality Registered and unregistered passports, driver´s licenses, ID cards, stamps, Visa, school Diplomas and other products for a number of countries like:USA, Australia, Belgium,Brazil, Canada, Italian,Finland, France, Germany, Israel, Mexico, Netherlands, South Africa,Spain,
    United Kingdom.

    CONTACT OUR SUPPORTERS

    Contact e-mails:=========== documentswithcom@gmail.com


    -------------------------------------------
    DO NOT HESITATE TO CONTACT US BY EMAIL,CALL,SKYPE OR WHATSAPP AT ANY TIME AND ANY DISCRETION.

    ReplyDelete
  20. buy ssd chemical solution for cleaning black coated currency


    Hello Everyone!
    Our chemical solution, can clean deface currency, such as EUROS, POUNDS, DOLLARS, We are professional in cleaning Deface notes, Coated note, Anti-breeze bank notes, etc. we also specialize in the manufacturing of SSD chemical Solution and Mercury activation powder used in cleaning all type of blackened, tainted and defaced notes. Our technicians are highly qualified and are always ready to handle the cleaning perfectly. We have more than 1000 professional in Laboratory who are assigned for the cleaning of deface currency. Our chemical solution is very effective and reliable.
    Our solution is 101% pure with Guarantee. We clean all types of black, green,white note or deface note. anti-air breezed powders, Activation powder and other many products used in cleaning black note. We do offer the best professional services. Kindly Contact us now for SSD Chemicals and services. Kindly call us immediately to help you out in the cleaning of your deface currency.

    Contact us Today with using the information below:


    Email: scenter650@gmail.com


    WE SHALL NEVER DISAPPOINT YOU

    ReplyDelete
  21. Real Estate and loan providers from 5000 Euro to 1,000.000.00Euro (no upfront payment is required)

    We are REAL ESTATE AND ANGEL INVESTORS, ... We offer the following services: We Buy All kind of Houses (if you have a House for sell, We can Buy it), We fund Projects of companies and Individuals, We Orientate clients on their Business, we give personal loans, business loans and corporate loans,investment loans, car loan, Debt consolidation, line of credit, second mortgage, purchase credit loans personal. and all types of loan with an interest rate of 2% For more information contact us via e-mail :info.realdealers@gmail.com

    Borrower information NEEDED
    Name:
    country:
    Sex:
    Age:
    Phone:
    Amount Needed:
    Occupation:
    Loan Duration:

    Greetings.

    Real Estate and Loan Providers

    ReplyDelete
  22. GENUINE LOAN OFFER WITH 3% INTEREST RATE APPLY NOW

    Have you been online looking for a legit and genuine Loan to pay off your Bills or Start Up a Business of your own? Have you being turn down by your Bank or other Lender's online? Here is a place were you can get QUICK and EASY LOAN without any delay or problem, apply today and contact us Directly on our website below for more information and get funded asap with any amount you need as Loan today, We do not require any upfront and our Loan can be issued within 5 Days. Why not give it a try.Contact via email info.realdealers@gmail.com directly from the contact page and we will reply you ASAP.

    ReplyDelete
  23. Hello I'm isaac egbong by name, I'm giving a testimony about Dr. okougbo the great Herbalist, he has the cure to all manner of diseases, he cured my HIV disease, though I went through different website I saw different testimonies about different spell casters and herbalist, I was like: "Many people have the HIV cure why are people still suffering from it?" I though of it, then I contact Dr. okougbo via email, I didn't believe him that much, I just wanted to give him a try, he replied my mail and Needed some Information about me, then I sent them to him, he prepared it (CURE) and sent it to FEDex Online Courier Service for delivery, he gave my details to the Courier Office, they told me that 3-5 days I will receive the package and i took the medicine as prescribed by him and I went for check-up 2 weeks after finishing the medicine, I was tested HIV negative, if you are HIV positive do me a favor for you to contact him and I will try my possible best to make sure you get cured, when you contact him, make sure you tell him that I referenced you.. contact him via: dr.okougbospellhome@gmail.com. or whatsapp him +2349032690878, contact me on isaacegbong23@gmail.com http://shaunreginal21.wordpress.com/2014/08/20/hiv-cure/ www.dr-okougbowebs.com

    ReplyDelete
    Replies
    1. Dr MABUWA is a great healer that can heal your disease. i was cured from HSV 1 and HSV 2 VIRUS after i contacted from my boyfriend after he cheated and since 2years ago i had been living a life full of fear. but when i surfed on the internet one morning and i saw comment on Dr MABUWA curing deadly disease. HERPES.HIV.DIABETES.HPV.HBV. CANCER and many more. i was skeptical that he might not be real then i decided to give a try to him. and as i did i never regretted contacting the great Dr MABUWA. he told me the ways and how to get my herbal medicine i believe and worked with him and he sent me my herbal medicine and as i received it he gave me instruction on how i will take it and i also gave my boyfriend to also drink because i really love him. despite he cheated on me. and behold Dr MABUWA said after 2weeks of usage we should go for test and as we did. our result both came out negative. Many lives has been saves because of you sir. may you ever reign and may God bless you more. you can reach him on his Email:drmabuwasolutioncuretemple@gmail.com or his What app Mobil:+2348130714541 or visit his Webs:https://drmabuwasolutioncu.wixsite.com/drmabuwa

      Delete
  24. Dr MABUWA is a great healer that can heal your disease. i was cured from HSV 1 and HSV 2 VIRUS after i contacted from my boyfriend after he cheated and since 2years ago i had been living a life full of fear. but when i surfed on the internet one morning and i saw comment on Dr MABUWA curing deadly disease. HERPES.HIV.DIABETES.HPV.HBV. CANCER and many more. i was skeptical that he might not be real then i decided to give a try to him. and as i did i never regretted contacting the great Dr MABUWA. he told me the ways and how to get my herbal medicine i believe and worked with him and he sent me my herbal medicine and as i received it he gave me instruction on how i will take it and i also gave my boyfriend to also drink because i really love him. despite he cheated on me. and behold Dr MABUWA said after 2weeks of usage we should go for test and as we did. our result both came out negative. Many lives has been saves because of you sir. may you ever reign and may God bless you more. you can reach him on his Email:drmabuwasolutioncuretemple@gmail.com or his What app Mobil:+2348130714541 or visit his Webs:https://drmabuwasolutioncu.wixsite.com/drmabuwa

    ReplyDelete
  25. Greetings to you all, i am here today on this forum giving a life testimony on how Dr.Aluya has cured me from HERPES VIRUS, i have been stocked in bondage with this virus for almost 2 years now, i have tried different means to get this sickness out of my body i also heard there was no cure to the virus, all the possible ways i tried did not work out for me, i do have the faith that i was going to be cured one day, as i was a strong believer in God and also in miracles, One day as i was on the internet i came across some amazing testimonies concerning how Dr Aluya has cured different people from various sickness with his Herbal Herbs Medicine, they all advised we contact Dr Aluya for any problem, with that i had the courage and i contacted Dr.Aluya i told him about my Sickness, He told me not to worry that he was going to prepare some Herbal Medicine for me, after some time in communication with Dr.Aluya, he finally prepared for me some herbs which he sent to me and he also gave me prescriptions on how to take the herbal medicine , My good friends after taking Dr.Aluya Herbs for some weeks i started to experience changes in me and from there, I noticed my HERPES VIRUS was no longer in my body, as i have also gone for test, Today i am fit and healthy to live life again, I am so happy for the good work of Dr.Aluya in my life, Friends if you are having any time of disease problem kindly email Dr.Aluya on { Dr.Aluyasolutiontemple@yahoo.com} or call him on +2347064851317} you can also visit him on his website Aluyasolutiontemple.webs.com for help God Bless you Sir.

    ReplyDelete