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.


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56 comments:

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    Replies
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  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?

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

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  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.

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  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?

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  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.

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

    Prostate Cancer Treatment

    ReplyDelete
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    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
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  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. 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
  16. 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

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  22. 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
  23. 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


  24. short testimony on how i got my yeast and herpes virus cured
    I found out ive had herpes about a year and 7 months ago I had my first outbreak it sucked but I only had one sore and it.was nasty enough.. I now am having my second outbreak and there about 5 and my vagina is swollen ive had it for about 4 week.now it started as a yeast infection then transformed into herpes ive been washing up after every time of going pee I take baths that seems to help with the pain a little bit.. Ive been taking this pill called zovirax 200mg I have also been using Tee Tree twice a week and then using Wartner every 2 weeks. and its not gettin any better.. I also dry it with a blow dryer and make it cold... until i come in contact with Dr.Okeyto who help me Get Rid of it Permanently with Herbs/Herbal Cure.contact him for any kind of help as well Email;[dr.okeytoherbalcure@gmail.com] or..his facebook page https://www.facebook.com/Drokeytoherbalcurecenter-311095186056996/.. /. or call him +2349050141440/whats-app
    thanks i am posting this to help those i can and for what Dr.Okeyto has done for me God will continue to bless him for me

    ReplyDelete
  25. I never thought i would be HIV negative again after been diagnosed in 2015, i have tried everything possible in life from one doctor to another, one hospital to another, series of tests, different kinds of medication, i had already lost hope until i meet Great Dr. OSAGIE online testimonies, a specialist in herbal medication from Africa, i contacted him (drosagiesolutiontemple@gmail.com OR
    DROSAGIESOULTIONTEMPLE@YAHOO.COM) and he prepared HIV herbal medication for me which i took for 7days and now i am completely cured. i want to use this medium to express my gratitude to him for saving my life and curing me from HIV, for taking away all my pains and sorrows, I''m indeed grateful and i am so happy I''m now HIV negative. i will continue to tell the good news of your great works to everyone, if you have HIV or other disease contact him, Email: his email: (drosagiesolutiontemple@gmail.com OR
    DROSAGIESOULTIONTEMPLE@YAHOO.COM ) or His Whatsapp number: +2347030465649...thank you my great dr for curing me keep up your great work...

    ReplyDelete
  26. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David Clara I’m a citizen of United Kingdom, My younger sister was sicking of breast cancer and her name is David Sandra I and my family have taking her to all kind of hospital in UK still yet no good result. I decided to go to the internet and search for cancer cure so that was how I find a lady called peter Lizzy she was testifies to the world about the goodness of a herbal man who has the root and half to cure all kind of disease and the herbal man email was there. So I decided to contact the herbal man for my younger sister help to cure her breast cancer. I contacted him and told him my problem he told me that I should not worry that my sister cancer will be cure, he told me that there is a medicine that he is going to give me that I will cook it and give it to my sister to drink for one week, so I ask how can I receive the cure that I am in UK, he told me

    That I will pay for the delivery service. The courier service can transport it to me so he told me the amount I will pay, so my dad paid for the delivery fee. two days later I receive the cure from the courier service so I used it as the herbal man instructed me to, before the week complete my sister cancer was healed and it was like a dream to me not knowing that it was physical I and my family were very happy about the miracle of Doctor so my dad wanted to pay him 5 million us dollars the herbal man did not accept the offer from my dad, but I don't know why he didn't accept the offer, he only say that I should tell the world about him and his miracle he perform so am now here to tell the world about him if you or your relative is having any kind of disease that you can't get from the hospital please contact dr.sakuraspellalter@gmail.com or whatsapp him +2348110114739 visit his website Drsakuraspellalter.webs.com for the cure, he will help you out with the problem. And if you need more information about the doctor you can mail me davidclara223@gmail.com or whatsApp me +1(6)31906022

    ReplyDelete
  27. I never thought i would be HIV negative again after been diagnosed in 2015, i have tried everything possible in life from one doctor to another, one hospital to another, series of tests, different kinds of medication, i had already lost hope until i meet Great Dr. OSAGIE online testimonies, a specialist in herbal medication from Africa, i contacted him (drosagiesolutiontemple@gmail.com OR
    DROSAGIESOULTIONTEMPLE@YAHOO.COM) and he prepared HIV herbal medication for me which i took for 7days and now i am completely cured. i want to use this medium to express my gratitude to him for saving my life and curing me from HIV, for taking away all my pains and sorrows, I''m indeed grateful and i am so happy I''m now HIV negative. i will continue to tell the good news of your great works to everyone, if you have HIV or other disease contact him, Email: his email: (drosagiesolutiontemple@gmail.com OR
    DROSAGIESOULTIONTEMPLE@YAHOO.COM ) or His Whatsapp number: +2347030465649...thank you my great dr for curing me keep up your great work...

    ReplyDelete
  28. My names are HARRY MARY I’m a citizen of United Kingdom, My younger sister was sicking of breast cancer and her name is HARRY Sandra I and my family have taking her to all kind of hospital in UK still yet no good result. I decided to go to the internet and search for cancer cure so that was how I find a lady called peter Lizzy she was testifies to the world about the goodness of a herbal man who has the root and half to cure all kind of disease and the herbal man email was there. So I decided to contact the herbal man for my younger sister help to cure her breast cancer. I contacted him and told him my problem he told me that I should not worry that my sister cancer will be cure, he told me that there is a medicine that he is going to give me that I will cook it and give it to my sister to drink for one week, so I ask how can I receive the cure that I am in UK, he told me

    That I will pay for the delivery service. The courier service can transport it to me so he told me the amount I will pay, so my dad paid for the delivery fee. two days later I receive the cure from the courier service so I used it as the herbal man instructed me to, before the week complete my sister cancer was healed and it was like a dream to me not knowing that it was physical I and my family were very happy about the miracle of Doctor so my dad wanted to pay him 5 million us dollars the herbal man did not accept the offer from my dad, but I don't know why he didn't accept the offer, he only say that I should tell the world about him and his miracle he perform so am now here to tell the world about him if you or your relative is having any kind of disease that you can't get from the hospital please contact drsujuherbalhome@gmail.com or call <+2348168259521> he will help you out with the problem. And if you need more information about the doctor you can mail me harrymary691@gmail.com

    ReplyDelete
  29. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David
    Clara I’m a citizen of United Kingdom, My younger sister was sicking of
    breast cancer and her name is David Sandra I and my family have taking her
    to all kind of hospital in UK still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the root and half to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man for my
    younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in UK, he told me

    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com or whatsapp him
    +2348110114739 <+234%20811%20011%204739> for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com or whatsApp me +1(6)31906022

    ReplyDelete
  30. I was cured of HIV with the used of natural herbs. My name is celina jolly and am from US. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured 8 months ago, i suffered from HIV for 13 yrs but with the help of Dr.Ogun herbal medicine, i was cured within few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as i heard she had herpes, i quickly refer her to Dr.Ogun and she was cured too after drinking his herbs.I have referred more than 15 persons to Dr.Ogun and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Ogun now, he is a herbalist doctor, i assured you of a cure if you drink his natural herbs. Dr.Ogun have herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, HBP, STD, cancer, chronic, etc. Contact Dr ogun through his Email address on: drogun62@gmail.com or WHATSAPP/CALL him on+2348104991149 . Please share the good news to other people once you are cured

    ReplyDelete


  31. Am here to appreciate Dr.Zack Balo for using his herbal medicine to cure my Herpes virus. since 2016 now I have been living with this virus and it has been giving me challenges, I was so perplexed cause i have been taking several drugs to be cured but all of my effort was in vain,one evening i was browsing through the internet then i saw several testimonies about Dr.Zack Balo curing people from Herpes virus and immediately i contacted Dr.Zack Balo on his email address: wiseindividualspell@gmail.com, i told him about my sickness and he told me that i will be cured within 14 days, gave me some instructions and which i rightly followed. so he prepared a herbal medicine for me and sent it to me which i used for 2 weeks and everything was like a dream to me and my Herpes virus was totally gone, why don't you contact him today and be free from your diseases because he is very good and honest Doctor. contact him via email address;wiseindividualspell@gmail.com or call or text him on his phone number +13203967742.

    ReplyDelete

  32. I am tina from USA , I Never believed i was ever going to be HIV Negative again,Dr PETER has given me reasons to be happy, i was HIV positive for 5years and all the means i tried treatment was not helpful to me, but when i came on the Internet i saw great testimony about Dr PETER on how he was able to cure someone from HIV, this person said great things about this man, and advice we contact him for any Disease problem that Dr PETER can be of help, well i decided to give him a try, he requested for my information which i sent to him,and he told me he was going to prepare for me a herbal medince, which he wanted me to take for days,and after which i should go back to the hospital for check up, well after taking all the treatment sent to me by Dr PETER i went back to the Hospital for check up, and now i have been confirmed HIV Negative, friends you can reach Dr PETER on any treatment for any Disease he is the only one that can solve your problem, reach him on Dr PETER on his email ayokospellcaster@gmail.com  or call him or whatSapp him on +2348132537313 HE IS ALSO SPECIALISED TO CURE ANY KIND OF DISEASE
    (1) CANCER,
    (2) DIABETES,
    (3) HERPES SIMPLEX DISEASE,
    (4) URINARY TRACT INFECTION,
    (5IMPOTENCE
    (6) BARENSS/INFERTILITY
    (7) DIARRHEA
    (8) ASTHMA
    HIS SOLUTION TO ALL YOUR PREDICAMENTS CONTACT him Email
    ayokospellcaster@gmail.com or whastsup hem on this very number. +2348132537313

    ReplyDelete

  33. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are Robert Mary
    I’m a citizen of United Kingdom, My younger sister was Sicking of
    breast cancer and her name is Robert Jane, I and my family have taking
    her to all kind of hospital in UK still yet no good result. I decided
    to go to the internet and search for cancer cure so that was how I
    find a lady called Sarah peter she was testifies to the world about
    the goodness of a herbal man who has the root and half to cure all
    kind of disease and the herbal email was there. So I decided to
    contact the herbal man for my younger sister help to cure her breast
    cancer. I contacted him and told him my problem he told me that I
    should not worry that my sister cancer will be cure, he told me that
    there is a medicine that he is going to give me that I will cook it
    and give it to my sister to drink for one week, so I ask how can I
    receive the cure that I am in UK, he told me
    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid
    for the delivery fee. two days later I receive the cure from the
    courier service so I used it as the herbal man instructed me to,
    before the week complete my sister cancer was healed and it was like a
    dream to me not knowing that it was physical I and my family were very
    happy about the miracle of Doctor so my dad wanted to pay him 5
    million us dollars the herbal man did not accept the offer from my
    I should tell the world about him and his miracle he perform so am now
    here to tell the world about him if you or your relative is having any
    kind of disease that you can't get from the hospital please contact
    Dr.ogididanspelltemple@gmail.com or WhatsApp him +2347067393105 for the cure, he will help you out
    with the problems.To get more information you can message me via email robertmary8947@gmail.com

    ReplyDelete
  34. HOW MY HERPES VIRUS WAS CURED BY DOCTOR IDEMUJAD

    Hi there everyone, i want to give my testimony on how i get cured of herpes virus, i want to thank God for sending Doctor Idemujad that cured me of herpes virus, I have been with herpes virus for 13 years, i thank God that i am healed from this virus, I was 28 when I started seeing symptoms. I really don’t know where to begin… But I use to think that I will grow old with this virus in my body, because i have use so many different type of drugs, believing that i will get cured of this virus, but it was not cured, i do not know what else to do, i keep on believing in God that one day i will be cured of this deadly virus called herpes, i was Praying for healing over every part of my body. Praying that the blood of Jesus washes over me, and that the lord breaks the binds of any diseases, pains, and illnesses, I feel my life is completely taken away from me, but i still keep believing in God, i believe that God will send a helper to me that will direct me on how i will be cured of this disease called herpes, one day i think of going for research in google, i saw so many testimony on how Doctor Idemujad cured so many types of disease, in my faith i believe that he will also cure me if he cured others i will also be cured, so i took his contact and contacted him for help, To God be the glory he directed me and cured my herpes virus that i have sick for 13 years, i want to give God thanks for he to send me a helper that cured my herpes virus, also give thanks to Doctor Idemujad for curing me of herpes virus that i have sick for 13 years, so if you are sick of any kind of disease and you need cure, you can contact him on email: idemujadherpescurecenter@gmail.com May the Lord that sent Doctor Idemujad to cure my disease will also cure your disease, thanks to you all God bless you.

    ReplyDelete
  35. I was cured of HIV with the used of natural herbs. My name is celina jolly and am from US. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured 8 months ago, i suffered from HIV for 13 yrs but with the help of Dr.Ogun herbal medicine, i was cured within few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as i heard she had herpes, i quickly refer her to Dr.Ogun and she was cured too after drinking his herbs.I have referred more than 15 persons to Dr.Ogun and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Ogun now, he is a herbalist doctor, i assured you of a cure if you drink his natural herbs. Dr.Ogun have herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, HBP, STD, cancer, chronic, etc. Contact Dr ogun through his Email address on: drogun62@gmail.com or WHATSAPP/CALL him on+2348104991149 . Please share the good news to other people once you are cured.

    ReplyDelete
  36. I was cured of HIV with the used of natural herbs. My name is celina jolly and am from US. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured 8 months ago, i suffered from HIV for 13 yrs but with the help of Dr.Ogun herbal medicine, i was cured within few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as i heard she had herpes, i quickly refer her to Dr.Ogun and she was cured too after drinking his herbs.I have referred more than 15 persons to Dr.Ogun and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Ogun now, he is a herbalist doctor, i assured you of a cure if you drink his natural herbs. Dr.Ogun have herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, HBP, STD, cancer, chronic, etc. Contact Dr ogun through his Email address on: drogun62@gmail.com or WHATSAPP/CALL him on+2348104991149 . Please share the good news to other people once you are cured.'

    ReplyDelete
  37. WHAT A GREAT MIRACLE THAT I HAVE EVER SEE IN MY LIFE. My names are David
    Clara I’m a citizen of USA, My younger sister was sicking of
    breast cancer and her name is David Sandra I and my family have taking her
    to all kind of hospital in USA still yet no good result. I decided to go to
    the internet and search for cancer cure so that was how I find a lady
    called peter Lizzy she was testifies to the world about the goodness of a
    herbal man who has the root and half to cure all kind of disease and the
    herbal man email was there. So I decided to contact the herbal man for my
    younger sister help to cure her breast cancer. I contacted him and told him
    my problem he told me that I should not worry that my sister cancer will be
    cure, he told me that there is a medicine that he is going to give me that
    I will cook it and give it to my sister to drink for one week, so I ask how
    can I receive the cure that I am in USA, he told me

    That I will pay for the delivery service. The courier service can
    transport it to me so he told me the amount I will pay, so my dad paid for
    the delivery fee. two days later I receive the cure from the courier
    service so I used it as the herbal man instructed me to, before the week
    complete my sister cancer was healed and it was like a dream to me not
    knowing that it was physical I and my family were very happy about the
    miracle of Doctor so my dad wanted to pay him 5 million us dollars the
    herbal man did not accept the offer from my dad, but I don't know why he
    didn't accept the offer, he only say that I should tell the world about him
    and his miracle he perform so am now here to tell the world about him if
    you or your relative is having any kind of disease that you can't get from
    the hospital please contact dr.sakuraspellalter@gmail.com/ drsakuraspellalter.wordpress.com or whatsapp him
    +2348110114739 for the cure, he will help you out with the
    problem. And if you need more information about the doctor you can mail me
    davidclara223@gmail.com

    ReplyDelete
  38. I have been suffering from (HPV) disease for the past four years and had constant pain, especially in my knees. During the first year,I had faith in God that i would be healed someday.This disease started circulating all over my body and i have been taking treatment from my doctor, few weeks ago i came on search on the Internet if i could get any information concerning the prevention of this disease, on my search i saw a testimony of someone who has been healed from (Hepatitis B and Cancer) by this Man Dr Iyoha and she also gave the email address of this man and advise we should contact him for any sickness that he would be of help, so i wrote to Dr Iyoha telling him about my (Herpes Virus) he told me not to worry that i was going to be cured!! hmm i never believed it, well after all the procedures and remedy given to me by this man few weeks later i started experiencing changes all over me as the Dr assured me that i have cured,after some time i went to my doctor to confirmed if i have be finally healed behold it was TRUE, So friends my advise is if you have such sickness or any other at all you can email driyohasolutiontemple@yahoo.com
    Call or Text him number +1 (407) 337-9869.

    ReplyDelete
  39. I was cured of HIV with the used of natural herbs. My name is celina jolly and am from US. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured 8 months ago, i suffered from HIV for 13 yrs but with the help of Dr.Ogun herbal medicine, i was cured within few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as i heard she had herpes, i quickly refer her to Dr.Ogun and she was cured too after drinking his herbs.I have referred more than 15 persons to Dr.Ogun and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Ogun now, he is a herbalist doctor, i assured you of a cure if you drink his natural herbs. Dr.Ogun have herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, HBP, STD, cancer, chronic, etc. Contact Dr ogun through his Email address on: drogun62@gmail.com or WHATSAPP/CALL him on+2348104991149 . Please share the good news to other people once you are cured

    ReplyDelete
  40. I was cured of HIV with the used of natural herbs. My name is celina jolly and am from US. I love herbs so much. Most times, injection and drugs are just a waste of time. I was cured 8 months ago, i suffered from HIV for 13 yrs but with the help of Dr.Ogun herbal medicine, i was cured within few weeks of drinking the herbs he sent to me through courier delivery service. This same doctor also cured my Aunty from herpes, as soon as i heard she had herpes, i quickly refer her to Dr.Ogun and she was cured too after drinking his herbs.I have referred more than 15 persons to Dr.Ogun and they were all cured from their various illness. Have you taken herbs before?. You have spent so much money on drugs,injections,surgeries etc and yet you have no good result to show for it. Contact Dr. Ogun now, he is a herbalist doctor, i assured you of a cure if you drink his natural herbs. Dr.Ogun have herbs that cures Hiv, Herpes, diabetics, asthma, hepatitis, HBP, STD, cancer, chronic, etc. Contact Dr ogun through his Email address on: drogun62@gmail.com or WHATSAPP/CALL him on+2348104991149 . Please share the good news to other people once you are cured

    ReplyDelete
  41. All thanks to Dr Ogudugu just contacted this man after my husband of about 4years left me and to my surprise it took this man just 3days to bring him back to Dr Ogudugu his the best spell caster around to solve any problem for you.
    {1} HIV/AIDS
    {2CANCER
    {3}HERPES
    {4}DIABETES
    (5}HERPERTITIS B

    Email: GREATOGUDUGU@GMAIL.COM
    Call/WhatsApp:+27663492930

    ReplyDelete
  42. My name is Amelia, I want to use this medium to thank Dr. Iyabiye, for saving me from CHRONIC HEPATITIS B. I suffered this ailment for 3 years, then this fateful day browsing through the internet to see if I could get help, I saw his contact and testimonies of others he has cured. I contacted him for help, and afterwards he administered his medication on me, I was confirmed cured and hepatitis free at the hospital after the treatment. You too can be cured like me if interested, reach him through his contacts: (+2348072229413 or +2348158577300) email: (iyabiyehealinghome@gmail.com)

    ReplyDelete
  43. If you have Herpes in your whole body such as fever blisters, hsv, or roofing shingles you know what it is like to stay with the pain and discomfort that herpes delivers. I don't need to tell you how awesome it would be to find something that works so well that you no longer need to fear about stress or outbreak,Dr Itua herbal medicine cure my herpes in two weeks of taking it.is genuine and natural herbal medicine it has no side effect, The reason I'm writing this is that I promised Dr Itua I will share his herbal work to the world to see Herpes is no more a big deal.also Dr Itua can as well cure the following diseases...HIV,Hsv 1/2,Hepatitis B,Breast Cancer, Cervical Cancer,Leukuemia Cancer,Lung Cancer,Brain CANCER,Blood Cancer,Prostate Cancer,Diabetes, Men/Woman Infertility, Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
    Syndrome Fibrodysplasia Ossificans Progressiva.Fatal Familial Insomnia Facator V Leiden Mutation , Lottery Spell,Copd, Shingles,Fibroid, Fibromyalgia, Liver/Kidney Inflamotry, Epilepsy,Hpv,Weak Erection,Wart Remover,Cold Sore, Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Glaucoma., Cataracts,Macular degeneration,Cardiovascular disease,Lung disease.Enlarged prostate,Osteoporosis.Alzheimer's disease,
    Dementia.Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic Asthma. Here His Contact...drituaherbalcenter@gmail.com/ . Whatsapp Phone.+2348149277976. I paid for his herbal medicine and sent it to me through Courier Service which I pick it urgently and used.

    ReplyDelete
  44. I'm so exited to share my testimonies about the Good Work of Dr. Udebhu who get me cured from herpes simplex virus (HSV1&2) with his herbs, I never thought that I will live on earth before the year runs out. I have been suffering from herpes, I had spent a lot of money going from one Hospital to another looking for way to get rid of this disease, the hospital have been my home everyday residence. Constant checks up have been my hobby not until this faithful day, I was searching
     through the internet, I saw a testimony on how Dr.Udebhu helped someone in curing his herpes disease using his healing
     Herbs, quickly I copied his email just to give him a test I spoke to him, he told me that he is going to provide the herbal cure to me, which he
    did, after i receive his herbs and i take it as instructed i was cure permanently from herpes my herpes disease was gone. so I decided to share my testimony, that nothing is impossible with God, God use a man to healed me. No matter what you are passing through, no matter how deadly the sickness is and no matter what the situation is God that did mine is still going to do yours, people suffering from herpes, brain tumor, kidney disease, pcos, AIDS, ALS,copd, asthma, athritis,herpes, Cancer,Hpv, any kind of disease, you can rich him now via ? Gmail address: drudebhuherbalhome@gmail.com or whatsapp +2349051254152  

    ReplyDelete
  45. I am so Happy to be writing this article in here, i am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX VIRUS . I was positive to the deadly Virus called HERPES and i lost hope completely because i was rejected even by my closet friends. i searched online to know and inquire about cure for HERPES and i saw Dr ehiaguna testimony online on how he was cured so many persons from Herpes Disease. so i decided to contact the great herbalist because i know that nature has the power to heal everything. i contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! after 2 days of contacting him, he told me that the cure has been ready and he sent it to me via FEDEX  and it got to me after 4 days! i used the medicine as he instructed me (MORNING and EVENING) and i was cured! its really like a dream but i'm so happy! that's the reason i decided to also add more comment of Him so that more people can be saved just like me! and if you need his help,contact his Email: (drehiaguna@gmail.com) you can contact him on whatsapp +2348073908953 . He also cure the below listed sickness; (1) HERPES, (2) DIABETES, (3) HIV&AIDS, (4) URINARY TRACT INFECTION, (5) HEPATITIS B, (6) IMPOTENCE, (7) BARENESS/INFERTILITY (8) DIARRHEA (9) ASTHMA...

    ReplyDelete
  46. I’d commend using Dr. Utu Herbal Cure topically for instant pain and itch relief as well as accelerated healing of lesions and permanently stopping herpes virus outbreaks. I have tried just about everything from acyclovir suppressive therapy to different natural oils, extracts, and other natural methods, some of which are EXTREMELY painful and exacerbate the problem (i.e. apple cider vinegar!). While vitamin E oil and suppressive therapies worked well for me, when I became pregnant I went back to trying to find a herbal cure. I was using vitamin E oil topically for a while but it was thin and difficult to use and only seemed to prevent further outbreaks rather than getting rid of it. I contacted Dr. Utu Herbal Cure through my friend. To my surprise, I could tell my outbreak was starting to heal within only a few hours! No more itching and pain! Dr. Utu Herbal Cure that I used was liquid herbs in bottles, so it was very easy to use. It simply whiffs, but it works so I don’t care! The best part of my testimony was that I successfully delivered a herpes-free beautiful daughter without further medications. Anyone who has tried Dr. Utu Herbal Cure knows just how quickly those treatments can add up.
    Anyone can reach Dr. Utu through
    drutuherbalcure@gmail.com
    +2349072733661

    ReplyDelete