CSN Login
Members Online: 18

Recently Diagnosed and am a bit confused

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

I will be 73 yrs old in a month and am in excellent health, take no drugs of any kind, get plenty of exorcise and eat a mostly vegetarian diet. I am devastated, as I thought I would be the last person in the world to get this cancer. I had a biopsy due to a 5.2 PSA as part of a routine physical. 1 core (right side) out of 12 had cancer, but it has a Gleason of 8 (4+4). It is stage T1c. The pathologist is a specialist and only does prostate biopsies, so I have confidence in the scores being correct. I was immediately scheduled for a bone scan and a CT scan, which both turned out negative, which was a big relief.

I had my first meeting with the surgeon last Thursday to discuss my options and was told that I was not a candidate for seed implantation due to the high risk Gleason 8 and of course, "watchful waiting" is also off the table.

He recommends doing a RP with DaVinci robotic surgery over open surgery. He has done 500 of each. He wants me to see the radiation oncologist, which I am scheduled for on Friday, but he advises me that external beam radiation can mess up my chance for "salvage" surgery, as well as the hormones usually administered can have very unpleasant side effects. He did explain the possible "bads" of surgery, such as incontinence and ED. He also explained that he wouldn't know about exceeding the margin until he got in there and that would be a major determining factor on my chances for nerve sparing. Not quite sure what this "margin" is referring to, but I think it means whether or not the cancer is completely contained in the prostate proper and not in the nerves?

He showed me how to plug my numbers into the Sloan Kettering tool and my results look promising.

After reading many posts in this forum, I see that it doesn't appear to be as cut and dried as I've been led to believe.

Any experiences by others with similar numbers would be deeply appreciated and would be very helpful in helping me arrive at a decision.

Thanks,

AussiePup

P.S. I am not Australian .. My username refers to my Australian Shepherd dog, who helps keep me fit and sane.

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

AussiePup,
Sorry to hear about your diagnosis. It sounds like you have all ready begun the education part of your journey and want to encourage you to continue with learning all you can to fight this beast. It sounds like you are in overall good health since the doctor recommended the Davinci at age 73. Some doctors cut off the surgery option at age 70 but that depends on the patients overall health.
As you have mentioned the Gleason 8 puts you in the cateogry where something should be done sooner rather then later.

Typically when the prostate is removed the surgeon has to make a decision as to how wide to cut to remove all the cancer. The wider the cut can cause more problems with the urinary control and also with the nerve sparing. After the prostate is removed it is inked and sent to a lab. This is to determine if the cancer is totally contained in side of the inked area. In my Case a Gleason 7 (3+4) I had one positive margin on the inking. The cancer was found on one spot to the very edge of what was removed. This means that the surgeon either cut through that spot of cancer and maybe some cancer cells were left behind. So far I'm doing great at 20 months post Davinci. Also my surgeon estimated that on one of the nerve bundles he spared 100% and on the other bundle about 60% were spared.
I'm doing fine on the urinary control and ED Side with the help of a levitra tablet.
I'm age 56.

I would assume that your doctors reasoning is to 1. remove the cancer via surgery and see how you do. 2. If recurrance then you have radiation as a backup and 3. If still problems then you have the hormone therapy.

Some surgeons will perform surgery after radiation but the radiation causes scaring and makes the surgery more difficult.

If you haven't all ready read it get the book Surviving Prostate Cancer by Doctor Patrick Walsh. Its an excellent book and will help you get a grasp of your options. He talks about margins and actually discovered the 'erection nerve bundles' and how to spare them.

Best wishes and keep us updated on your progress. If you want to chat via phone or email offline just send me a private message through the email portion of this forum.

Lewvino (larry)

Oh yes - I love dogs and almost bought an australian sheperd this spring. Ended up with my favorite instead a golden retreiver.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

AussiePup

Sorry to hear of your diagnosis but welcome to the forum. There are many men here who have gone through similar circumstances and I'm sure you will get much support and advice based on their experiences.

As you know, your diagnosis is troubling because it indicates a higher risk cancer which has cells that are much less differentiated that a Gleason 3+3, for example. Assuming you have been having regular physicals where PSA testing was done, you should have a good history of your PSA scores. If you put them into the Sloan Kettering nomograms then you can calculate your PSA density, your PSA velocity, and PSA doubling time. All of these help give you some perspective on the aggressiveness of your cancer.

If I were you I would be heartened to know that only one core came back positive which may be an indication that the cancer tumor in your prostate is relatively contained. (Of course, it could also mean that they just missed any cancer in the other core samples).

Your doctor is right to have a sense of urgency about this and he is being smart to have you consult with a radiologist as well as his specialty. As Larry pointed out and your doctor alluded to, surgery following radiation for salvage therapy is more difficult but not impossible.

Your doctor may have discussed with you that there are differing opinions about whether surgery on a Gleason 8 cancer is prudent or not, your age notwithstanding. Gleason 8 cancers have a much higher probability that some of the cancer has moved outside your prostate even though the bone scan showed negative results. Removing the prostate after the cancer has spread will not slow the progression of cancer outside the gland. (Prostate cancer inside the prostate isn't fatal...but the relatively small percentage of men who DO die from prostate cancer succumb to the damage to their organs outside the prostate). On the other hand, if there is good evidence that the cancer is still contained, there have been some recent studies published that show excellent results in long term absence of recurrence following surgery. You should also consider that if indeed tha cancer is contained in the prostate, then several forms of radiation may also be appropriate.

One particular form of radiation that is frequently used with your stage of prostate cancer that is apparently contained within the gland is HDR brachytherapy where temporary radioactive wires are inserted into the prostate for a short period of time. This is frequently done in conjunction with a limited course of hormone therapy. When you meet with the radiologists, I would include HDR (High Dose Rate) brachytherapy on the list of possible treatment options to discuss.

Despite the fact that your pathologist apparently specializes in prostates, I would strongly encourage you to seek a second opinion from one of the major medical schools such as Johns Hopkins. The initial diagnosis in your case is so important and so much rides on it that i would go the extra mile on this.

You shouldn't feel guilty about leading a healthy lifestyle and coming down with prostate cancer. I'm not sure what a "mostly vegetarian" is but I would encourage you to read The China Study in addition to the standard issue prostate cancer books. I would also consider eliminating dairy if that is part of what you eat because of its strong association with the IGF factors and cassein which accelerate cancer growth.

Best of luck to you.

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

First, I have just ordered the book by Dr. Walsh ... Thanks Larry ... your results are encouraging and comforting ... definitely gives me hope

Kongo, you mention brachytherapy as an option. My doctor told me it's only for low risk patients ... that my Gleason 8 precluded that option. He said that external beam radiation is the option that would be open to me. He is the director of the urology oncology department at University of North Carolina hospital in Chapel Hill, NC. Of course, his specialty is surgery. Have you heard anything regarding this teaching hospital's expertise or success in this field?

I will let you know what the radiation oncologist tells me at my appointment on Friday.

This site is a wonderful resource ... I am so glad I found it!

Thanks to both of you,

Martin

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Martin,

While brachytherapy (permanent seeds) is generally considered a solution for low to medium risk patient, HDR brachytherapy is another story altogether with a much higher dose rate very precisely administered. Brachytherapy and HDR brachy should not be confused with each other.

Check it out at: http://www.prostate-cancer.org/education/localdis/demanes_HDR.html

Good luck.

K

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Kongo,

The link you furnished is an outstanding bit of info, that I thank you for and will be asking about HDR brachytherapy with the radiation oncologist on Friday. It sounds almost too good to be true! Of course, none of the tables cover my numbers, but that may just be due to covering only the most common number combinations.

Will keep you posted

Thanks again,

Martin

Julietinthewoods
Posts: 15
Joined: Dec 2010

Martin, I believe the combination treatment of ldr brachy followed (or preceded, depending on the doctor) by IMRT (modern external beam) could also be an option for you. I think brachytherapy as a monotherapy is the issue for higher grades of cancer. The combination of the two types of radiation gives a higher dose of greys and covers the margins. You might want to at least ask your radiation consultant about it.

From what I have read, your PSA (less than 10) and stage are both factors in your favor. I really wish you luck!

Juliet

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Juliet,

I will also be taking your comment with me on Friday and will let you know the outcome.

Thank you very much for your interest,

Martin

Swingshiftworker
Posts: 620
Joined: Mar 2010

I know it's possible, but I don't think I've ever heard of anyone w/a Gleason 8 (high grade cancer) also being diagnosed as Stage T1c (early stage cancer undetectable by DRE or imaging).

This apparent inconsistency suggests the need for a 2nd opinion on the biopsy. Dr. Jonathan Epstein at Johns Hopkins, who is one of the experts in the field, did a 2nd opinion for me and I highly recommend him. His contact information is available here: http://pathology.jhu.edu/department/services/consults/urologic.cfm.

If you really have a Gleason 8, surgery is usually suggested (but not absolutely mandated) as long as the cancer has not migrated beyond the prostate capsule. There are other radiological alternatives, as other have already suggested.

While your slides are out for reanalysis, take the time to investigate your options before submitting your body to the knife. The negative consequences of surgery are quite draconian and various forms of radiation treatment may still be the better choice.

BTW, don't let the suggestion that surgery after radiation is contraindicated deter you from choosing radiation over surgery as the primary treatment. If surgery fails you'll have no choice but to opt for radiation and/or chemo later, which are the same follow-up choices if the initial radiation treatment fails.

Good luck!

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

SwingShiftWorker,

Your comments are duly noted and will be considered in my decision making. The only think there is no doubt about is the stage T1c, as it is defined. I had the biopsy due to the elevated PSA and the tumor is not palpable or detectable during a DRE. Also, 3 different doctors have assigned T1c to me. I am considering asking for another pathologist's opinion on my slides.

Thank you for your interest,

Martin

mrspjd
Posts: 688
Joined: Apr 2010

Hi Martin,

Welcome to the PCa forum. A bit about our PCa journey: After multiple consults with skilled and experienced docs in all tx modalities, my husband, PJD, chose HDR-B as his primary treatment in combination with ADT (Androgen Deprivation Therapy aka hormones) and IMRT. He is doing very well with good results todate, enjoying golfing, skiing, working, exercising, etc. In all the confusion & fear of a cancer diagnosis, there is, afterall, for many, a good life after PCa!

Briefly, PJD was dx’d with PCa in Feb 2010 @ age 67. He was otherwise healthy, fit, and active, with no major pre-existing health issues. He had a history of low PSA’s. PSA @ dx was 2.8. Nodule found on DRE lead to a twelve core biopsy resulting in 9 cores positive with many of the nine cores @ 70-100% positive. Local pathology lab reported Gleason 3+3=6, stage T2 with PNI. PJD sent his biopsy lab slides out to a well known and respected PCa pathology lab, Johns-Hopkins, for a 2nd opinion reading. The J-H’s report downgraded (worse) the Gleason to 3+4=7, confirmed PNI (PeriNeural Invasion), and lead us to seek further diagnostic testing in order to determine the correct staging. We felt that establishing the correct pre-tx staging was critical in order to evaluate which tx would offer the best chance of successful outcome with the least side effects since no two cases of PCa are the same. Staging was ultimately determined to be intermediate/high risk T3 locally advanced PCa with ECE (extra-capsular extension).

If you wish to read a few of my recent summary postings relating to our PCa experience and HDR-B, they can be found in the following threads:
http://csn.cancer.org/node/193113 (May 2010 & March 2011 posts)
http://csn.cancer.org/node/215851 (April 9 & 14 posts)

To read more about a topic of interest or previous posts made by a particular user/board member, you may wish to take advantage of the search box feature located on the upper right side of the PCa forum home page. Just enter a topic, key word(s) or user’s name.

Once you have all the facts and educate yourself about your options, you will be able to make a tx choice that will be right for you. Wishing you all the very best.

mrs pjd

PS: Next to Springer Spaniels, Aussie Shepherds are great! Rescue dogs of course.

VascodaGama's picture
VascodaGama
Posts: 1519
Joined: Nov 2010

Martin

You got here several comments to consider in your decisions to a treatment. However, none of the above suggestions can assure you cure. Treatments for prostate cancer are still not perfect (very “primitive”) and are based on “guess work”. You cut a “piece” of your body or burn it inside you, expecting that cancer is within it.
If, in fact the cancer is not totally in there, you end up with a recurrence, confronting side effects and “less money in the pockets”.

Quality of life should be considered at your age. Major radical treatments can harm you permanently which would not be part of your plans while advancing into the 80th.
There has been a tendency of avoiding radical approaches to guys over 70. The NCCN guidelines expresses that and recommend palliative treatments which are lesser aggressive.

I believe that you feel healthy and that you could withhold a treatment that would close this chapter of your life, but your “excellent health” status seems to have betrayed you. Many of us had the same experience and many (in the 70th) have reported to find other health complications while preparing for cancer treatment.

Prostate cancer is known to have a slow progress and guys in worse cases with metastases survive 8-10 years without any treatment. Others live long 10-15 years with hormonal treatments. I do not agree with your doctor’s opinion regarding hormonal treatment. The “very unpleasant side effects” he comments are symptoms similar to menopause (hot flashes, mood swings, etc) that disappear once the treatment is stopped. Many guys mistakenly relate hormonal therapy with that of chemotherapy which has nasty side effects.

One has to weigh the fact of living with the possibility of side effect or continue with quality of life and probably die younger of other illnesses.

I would recommend you to read about the side effects of each treatment and check about palliative treatments. O good book for cases similar to yours is “Beating Prostate Cancer” written by the famous oncologist Dr. Charles Myers himself a survivor of prostate cancer.
Another interesting story I recommend you to read, which was posted here before, is the fascinating experience of a surgeon when he confronted the position of being a PCa patient. You can read it here;
http://www.renalandurologynews.com/lessons-lived-ailments-get-personal-for-some-docs/article/200925/b

Here is the site for NCCN;
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

I hope you find that decision and peace of mind.

VGama

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Mrs PJD,

The posts in the links you furnished in this comment are very helpful. They have helped me put together some good questions to ask the radiation oncologist in tomorrow's meeting.

I love Springer Spaniels, too!

Regards and thanks again,

Martin

bdhilton
Posts: 752
Joined: Jan 2010

I always hate to hear about guy another falling victim to PCa…but from my perspective you are a very blessed man as I was diagnosed when I was 54….I had surgery but at your age with some of the complexities you mention I would be looking into some form of radiation (Kongo can you believe I am making this recommendation) that in my opinion would give you the best quality of life at your place in life…Whatever you decided I wish you the best….and Chapel Hill is a great teaching hospital!

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Thanks for you comments, bdhilton

I will post my impressions of tomorrow's meeting.

finbar
Posts: 26
Joined: Aug 2009

I had a very similar report on my p cancer. That was 3 years ago at age 82.
With the help of both patients and doctors, I looked into all the treatments
available and and soon came to the very solid decision to get rid of the cancer
once and for all. Once I settled on the Davinci robotics, the next step was
to find a surgeon with a great deal of experience having at least a 1,000 operations
a year. Not only saving as much of the nerve bundles as is possible but making
re-connections to the bladder is vital to a good outcome. I was most fortunate to
now have a near zero PSA that has been checked every six months. Should you wish
further info, I can emailed at alb212@gmail.com

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

finbar,

congratulations on your excellent results and progress.

I agree that it's very important to find a doctor with a great deal of experience in whatever specialty you are considering.

Does anyone have any idea what numbers are considered "a great deal of experience" for the different surgeries and radiation treatments?

Thanks,

Martin

guards
Posts: 72
Joined: Aug 2010

Get an opinion from an unassociated doctor. Hopefully they don't even know each other. I can't imagine how you can have an 8 off a 1 out of 12 but maybe another doctor can explain it better to you. At 73 seriously find out if it is slow growing and perhaps watchful waiting or hormone therapy will work for you. I promise you the side effects from surgery or radiation can cause significant changes in you life style and if you can have another 10-20 years without committing to more radical proceedures I for 1 (been there) reccommend consideration. I think that the doctors truly beleive that what ever they use is the best route but I think it is often not so. perhaps there is a suvivors group at your local hosp. you could talk to . You certainly are not critical right now take a few weeks or months to decide.

cooksey23
Posts: 2
Joined: May 2011

Found out when I was 48 years old that I had prostate cancer. Gleason 8 (4&4). Did the Davinci. Clean since June 2007. Other problems with CLL. Radiation and 4 rounds of chemo. Your life has changed but, always make the best of it. No matter what the side effects. Like for me, once in your life you have to think about you.

God Bless

Willie Teague
cooksey23@cox.net

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Sorry for any confusion that I may have caused by saying my appointment with the radiation oncologist was today ... it's not until tomorrow ... just got confused ... will post my impressions, etc. on the meeting over the weekend.

Thanks again to all,

Martin

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

I was diagnosed with psa of 24 and Gleason 9 in 2003 at age 52. The only treatment I took was the maximum radiation allowed. A second biopsy 3 years ago showed no cancer left in the prostate. My cancer had already spread so surgery was not a choice. You will have much less side effects with the radiation than with surgery and you will be able to get the cancer cells killed and at age 73 I woould think that would be the best option. But it is your decision and you will make the right one for you and I wish you all the best.

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Forgive the tardy response, but I sort of dropped off the face of the earth for awhile!

I will now bring my story up to date. I had the meeting with the radiation oncologist, who informed me that 8 weeks of radiation and 2 1/2 years of ADT hormone therapy would be his recommendation. I questioned him why the long ADT course of treatment and he said that that is the standard in the US and that in Europe, it's 3 years. I had gotten excited about Cyberknife, but was informed that, even though they have it, CyberKnife doesn't allow their equipment to be used on a high risk case, because they are still gathering data for their studies. Because of being a teaching hospital, none of the other options were open to me. He was young, but out of Stanford and Harvard with lots of stripes, so I tended to believe what he was telling me. I then had another meeting with the surgeon. Even though surgery is not generally considered after age 70, because of my excellent health, etc., he thought it was a good option and answered all of my other questions.

After talking with several friends, who have gone through it and digesting all that I had learned from this forum, it came down to a quality of life issue for me. 3 years of zero libido, hot flashes and many, many other possible side effects would put me at age 76 with no guarantees of anything. This was too much for me to swallow, so I made the decision to have the surgery.

After 3 different date changes, I had the DaVinci RP on July 12th. My catheter was removed on July 22nd The pathology downgraded my Gleason to 3+4 from 4+4. Margins were negative. No other cancer in the prostate. Nerves were mostly spared. Lymph nodes were clear. Followup is on Nov 4th to see new PSA

In short, I am feeling like the report and outcome couldn't have been better at this point. I am not going to bore you with all of my trials and tribulations with the catheter and other issues … I am down to using 1 pad a day and only have an occasional tiny leak when getting up from a sitting position.

The only concern that I have is the frequency that I need to pee. I'm going about every 1 1/2 hours. No problem going … not the strongest stream and a little dribbling at the end. I still get up at night about every 1 1/2 hours also … never leak at night sleeping or after the bathroom. Nurse tells me this is normal and not to worry, but I am a bit worried after reading some of the reports from others on this forum.

So would appreciate any info on this issue, as well as your thoughts on when it's ok to take a bath. Also, I have been having some discomfort in my ribs … don't know whether it's related or another issue … I have been weaning myself off of pain pills, so it could be related to that? Also, counting the drainage hole, there are a total of 6 incisions in my gut … has this been your experience to have this many holes?

Anyway, I've been worrying about not reporting on progress, so I now feel much better!

Thanks to all of you ... you've been of more help that you know and I deeply appreciate your interest,

Martin

lewvino's picture
lewvino
Posts: 1004
Joined: May 2009

Glad to hear that things are working out so well for you! The Downgrade is also great news and one advantage of having surgery! They send it to the lab and no exactly what they were dealing with!.

I remember having the frequent urination also following my Davinci. It will get better. Push the fluids of course but taper of around 5pm or so.

Yes the 6 holes are standard but they are small as combared to one HUGe incission if traditional surgery. Each person experiences pain different so don't fret about the pain pills. My pain level was more severe then I thought it would be. Hey I'm just a young one a 54 when I had my surgery. You are doing fantastic at your age! Let us know the PSA When you find out!

Lewvino

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Very appreciated ... I have a call in to the nurse line about this pain under my rib cage on the right side when I breath in ... I read where this could be some type of clot following my surgery ... will let you know what they say.

Martin

PawPaw J
Posts: 34
Joined: Jul 2011

You may bore the older members of this club with the trials and tribulations of the catheter and whatever else but for us new guys fixing to have surgery any comments to help or be aware of with catheter or anything else would surely be appreciated. I am only 5 days away from open surgery and instead of calming down I am getting very scared.Never been out for surgery that long and never had to recover from anything like this. So bring on the sugestions! Thanks, Johnny

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Hi Johnny,

I can relate to your scared feelings very well, having been there, done that! My feeling is that the worst is already behind you, since you've made your decision on direction and treatment. I agonized over mine a long, long time and can tell you that this board helped me immensely. I urge you to just spend a lot of time reading the posts that are related to your questions, treatment choice, interest, etc.. Use the search facility ... for example, search for catheter, pain, pee, combination of key words or whatever, and you will be amazed at how your search can be narrowed to focus just on the posts that are relevant to what you are interested in at that time.

As far as advice that I may be able to give, here are a few of the things that I learned from experience and that I believe would be helpful to you. I'm not going to second guess your decision in any way, as you need to believe in the one you've chosen to trust.

Catheter: it's definitely a hassle .. if you can hang around the house, it's much easier and better to carry the big bag around ... the leg bag is a hassle in several ways. Also, smear a little Bacitrin or equivalent onto the area where the catheter goes into your penis (miatus) .. definitely helps with soreness and unwanted sensation. Do this several times a day, if possible.

You will definitely have some pain ... please don't be afraid to use your pain medication, as needed. Can't stress enough how important it is to take the stool softener with the narcotics, as the one thing you don't want to do is strain with a BM.

Please let me know any specific questions you have that I may be able to shed some light on and if I can't, I assure you there are others who can! There are some extremely knowledgeable people posting on this forum and it's just a wonderful resource, so use it!!

I wish you all the best and will keep you in my prayers ... can't hurt and might help.

Best to you, Johnny,

Martin

PawPaw J
Posts: 34
Joined: Jul 2011

Martin, Hope your rib cage pain wasnt anything serious. Thanks for the info. I have finished all my pre-op testing and class and start my "clear-out" in about 2 hours. Hope to have good news in a week or so. Till then may God bless you all! Johnny

AussiePup's picture
AussiePup
Posts: 19
Joined: May 2011

Ok,

Last Friday, they took an xray and sure enough, there is something at bottom of my right lung. 2 doctors plus the radiologist have looked at it, but don't know what it is. Their best theory is that one of the robotic arms that entered from my right side bruised my lung, which they say sometimes happens. Since I had no fever or shortness of breath, etc., they did not seem too concerned and said to let them know how I'm doing on Tuesday.

Well, guess what, it has almost completely gone away .. no more chest pain or trouble breathing, etc.. Still am occasionally having a problem laying on my side, but that is getting better, too.

So the only question I have left and forgot to ask the doctors, is how can I tell when it's safe to soak in the tub. I still get these sensations around the miatus and it's the type of feeling that I think would respond to a soak! Not pain, just I don't know how to describe it!

Anyway, good luck and outcomes to all who are just starting on this journey. Not done, but definitely feel I'm coming down the home stretch now.

Thanks again to all who have responded to me with some awesome advice and information.

Martin

Subscribe with RSS
About Cancer Society

The content on this site is for informational purposes only. It is not a substitute for professional medical advice. Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

Copyright 2000-2014 © Cancer Survivors Network