CSN Login
Members Online: 13

You are here

Good site compares PC treatments - surprising results

grahambda
Posts: 18
Joined: Dec 2017

So after a series  of PSA tests over the past few months ranging from 10.8 to 11.5 and taking anitbiotics for 6-8 weeks wth not impact on PSA, also a recent DRE with some "firmness" identified on left lobe, off to get an MRI assisted biopsy. O joy !.  However my senior ongolosit already suggesting that IF the Gleeson score is 7 and above that robotic radical surgery is the way to go :-(

However I came across this site  https://prostatecancerfree.org/compare-prostate-cancer-treatments-high-risk/ . The data indicates that regardless if  you are intermediate or high risk that surgery is NOT the best course of action based on their findings of montioring several thousand PC patients. (Seeds and Seeds EBRT are indicating the best outcome).   Now like most if the Gleeson comes back postive  I want to get the cancer out  and eveything I have been told is that surgey is THE way to go to be sure of eradication if contained within the Prostate. However this site would suggest otherwise and I would much prefer seeds than surgery due to the potential of less side effects and better quality of life.  Downside you need to monitor on a regular basis for potential reoccurance but that vs the surgery alternative is an option I personally would prefer. Welcome any thoughts and input.

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi,

As you have said surgery offers the advantage that if the cancer is contained within the prostate and confirmed after surgery via disection of the gland there is a vey good chance that it will be over, no more cancer.  Yes there are side effects and depending on the skill of the surgeon will probably determine how severe & long lasting they are.  I my mind if I would have done one of the various forms of radiation I would alway wondered if they got all the cancer.  With radiation it's a very slow death for the cancer (declining PSA) which will take a few years to get to undetectable if it goes there at all.  If there is any healthy prostate tissue left after radiation can that also at a latter date turn cancerous due to the radiation?  According to most people who have had radiation on this board there are less side effects short term and long term.  Radiation can cause scar tissue to form where it hits both inside and outside the prostate.  All treatments have side effects. It up for you to decide which path you want to go down with all the info & tests conducted to point you in the right direction.  Base on the various surgery & radiation results on people who frequent this board I don't thinks there is a clear answer which route is better.  You have to make that decision based on the facts, not people like me or anyone else on the board.  We can only offer our stories for your consideration, the decision is up to you, not me or anyone else. From what I have learned from people on this board the higher the gleason score the more likely the cancer has escaped the gland, so radiation might be a better bet.  Did the MRI show total containment with the prostate?  

Dave 3+4

grahambda
Posts: 18
Joined: Dec 2017

Thanks for the input Dave. Yet to have the MRI/biopsy that is  scheduled for late this month. Again really surprised that the somewhat "knee-jerk" recommendation from both the GP and Snr Urologist  was to look toward Robotic Radical surgery with no gleeson scores or any other info (other than the > 10 PSA and lump noted via DRE and my age - 60.) I will update this posting as more info becomes available.  The journey begins.

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi,

Keep studying, you need the MRI results to guide the biopsy and determine where in your prostate the cancer is hiding.  Might want to look into a second opinion from another urologist and an oncologist to see if they agree with your present doctors.

Dave 3+4

ASAdvocate
Posts: 112
Joined: Apr 2017

You can compare surgery with most other treatments. What looks impressive with these results are Low Dose Brachytherapy (seeds) and High Dose Brachytherapy (no seeds) monotherapy. They have IMRT and SBRT bundled in under EBRT, and I wish that they had broken them out separately. Many men have found these charts to be very helpful in their discovering and investigating different types of treatments.

http://www.pctrf.org/intermediate-risk/

 

 

hopeful and opt...
Posts: 2218
Joined: Apr 2009

It was stated "All treatments have side effects.", however this is a  misleading statement,  since surgery has greater potential side effects than other treatments.

"I my mind if I would have done one of the various forms of radiation I would alway wondered if they got all the cancer.  "  

Since radiation has a similar cure rate to surgery this is not  an issue. If there is recurrance, with radiation or surgery, there are tests such as MRI and PET scans that can show cancer outside the prostate.

................................................

MRI 

The multiparametric mri can use various size magnets. The T3 MRI uses the most powerful magnet in clinical use, and provides the best definition to determine possible extracapsular extension, and the location of the cancers within the prostate. The MRI can in addition be used to target the biopsy...there is a three dimensional biopsy machine, that uses the latest technology to  lock into the results of the mrI to provide a biopsy that you can place better confidence in than the two dimensional biopsy used in most doctors offices. Generally some major centers of excellence have this machine.

 

grahambda
Posts: 18
Joined: Dec 2017

You are of course right- need to have all the data before a decision on treatment, however I am so not leaning toward surgery, for me it would be bottom of the treatment list.  The Urologist that is being recommended has apparently conducted 10,000 robotic radical surgeries!  My concern is that his answer will be surgery regardless of the question or the Gleeson scores.  I hate to be cynical but at 10,000 surgeries that is a pretty impressive, and no doubt lucrative, production line he has running. Let’s assume the technology has been available for say 15 years with an average of 10 months a year of surgeries,  that’s 3-4 a day (assumes 5 day week and 3 hours per procedure). 10 -13 hour days in the operating theatre, 5 days a week, 10 months a year for 15 years! Mind boggling.  If only data would be made available on those 10,000 that went through the operation with a focus on re-occurrence rates, incontinence and ED long term effects. Then one could make a very informed judgement on whether to go that route. It certainly will be a question I will be asking as part of the decision process.

Tech70
Posts: 50
Joined: Nov 2017

I find the claim of having done 10,000 robotic surgeries highly questionable

MK1965
Posts: 162
Joined: Jun 2016

grahambda;

Reading your comment about avoidance of surgery because of the highest risk of all possible SE, haigher then with any other treatment modality, its exactly what I think and experienced on my own skin. With surgery, you get it all and mostly forever and tottaly free of cost. That is platinum addition to your package. Once surgeon cuts out your prostate, you are just one more surgery under his belt and making him favor to sell more surgeries.

Take time to explore your options and make choice that is best for you, not for pro-surgery guys who claim superior outcome nor for me and many others who were not so fortunate.

The best treatment optiom for you is one that you can tolerate SE regardles if they are comming right away or in delayed fashion and one that you won't regret later as many of us here did.

I had RP 14 1/2 months ago and still at ABSOLUTE ZERO. No feelings, no stirings, no erections, lost 2+ inches of lenght, lots of girth etc. Spent already lots of maney for penile rehab meds, pumps, TRIMIX, BIMIX, siringes, doctors office visits and I do not see exit from this evills circle.

Read my latest post with excellent link on SE after prostatectomy: http://www.medscape.com/viewarticle/854273

Best of luck and best outcome whatever you choose.

MK

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi grahambda,

The one thing about this cancer is that there are quite a few choices for treament and we make our own individual treatment path from the info we have gathered and decided that this one treament is what I want.  Of course a urologist would push surgery, that's what he does for a living and you need to take that into account in making your decision. Another urologist might not push surgery some much.   There is no right or wrong treatment plan but the best one you choose for yourself.  As far as some of the statements Hope & Opt. makes I wanted to clarify a couple of things.

It was stated "All treatments have side effects.", however this is a  misleading statement,  since surgery has greater potential side effects than other treatments Depending on a lot of factors sometimes surgery side effects are less than radiation treaments based on the circumstances.  If you look at the manufactures web sites for both say Cyberknife & Davinchi they will list both short & long term side effects and both forms of treatments do have side effects, All teatments have side effects.  If there was one treament that did not have side effects a majority of people(me included) would choose that one, but there is not.  Each case is unique some better some worse, some surgeries go very well some don't, some radiation treatments go very well, some don't, so the statement surgery has greater potential side effects is not correct.  It all depends on the skill of the surgeon and how involved the cancer is inside of your prostate, each case is different

 

I my mind if I would have done one of the various forms of radiation I would alway wondered if they got all the cancer.  "  Since radiation has a similar cure rate to surgery this is not  an issue.  This is my personal opinion,  I was stating that I(me) would wounder with radiation if they got all the cancer.   I would still wounder because the radiation can change cell reproduction and possibly(yes possibly but not always) cause future cancer(s) where the radiation hits tissue whether it's bowel, bladder, or soft tissue.  It could happen, not saying it will happen.

Radiation & surgery do have similar cure rates but each type has different side effects, some long term, some short term.  Not promoting surgery over radation or radiation over surgery, pick the best treatment based on your set of circumstances from what your tests tell you.

Dave 3+4

ASAdvocate
Posts: 112
Joined: Apr 2017

The highest numbers of RP's that I have read about for one surgeon is 5,500 for Dr. Alan Partin of Johns Hopkins. He does both open and robotic methods. I beleive that his famous colleague, Patrick Walsh, did around 4,000 open RP's in his long career.

 

Dr. Samadi has claimed 3,600 robotic surgeries as of 2011, so he may be close to Partin's total now.

 

But, 10,000?  That seems really questionable.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Per the internet, As of 2/2010 he performed 3200 hundred; in 2013 he reports to have done over 5000.....so currently he probably has done about 10000 

If I were to have robotic surgery, which I willl not, this is the guy that I would hire....I understand that he perfected a technic to maintain sexual funchon.

....

 

There are also other world class surgeons, who have done a lot, but I did not do the research about the others.

1005tanner
Posts: 29
Joined: Dec 2017

Dr. Joseph Smith has done thousands of open before switching over to robotic in 1993 at Vanderbilt Hospital

in Nashville Tn. He has patients come from all over the world for his expertise. Great guy and very sincere

surgeon. Highly sought of doctor.

hopeful and opt...
Posts: 2218
Joined: Apr 2009

http://www.renalandurologynews.com/expert-qa/the-robotic-prostatectomy-interview-with-mani-menon-md/article/209414/

 

In 2011 Dr Menon and his group performed over 6000

more

 

https://www.google.com/search?authuser=0&ei=sIZeWuCoK9fIjwPui6iYCg&q=how+many+surgeries+has+Mani+Menon%2C+MD%2C++done&oq=how+many+surgeries+has+Mani+Menon%2C+MD%2C++done&gs_l=psy-ab.3...920321.929573.0.931028.3.3.0.0.0.0.109.296.2j1.3.0....0...1.1j2.64.psy-ab..0.0.0....0.wR9jXNBcXvQ

Steve1961
Posts: 199
Joined: Dec 2017

listen just daignosed myself...PSA 8    3 tumors 7 7 and 6 gleason score ...DRE   finger up the butt 5 times all negative...apparantly tumor size i 9 6 and 2 millimeters  which in not even .5 inch.  very small i am being told .so the quack who diagnosed me said radiology lol 40 sessions..the radiologist said i should take it out....so anyway i fired this group of jokers....i went to see a real urologist/sugeon...36 years experience...22 year specializing on prostarte cancer..he talked me out of surgury right away ..with all i stated about the stage i am in...he said i am stage one intermediate and dont need surgury..he has done over 2500 surguries  and he said surgury is the last thing anmyone wants...at my stage the cure rate is the same as taking it out...my wife uncle had brachytheropy  34 years ago at stanford  and he is now 76 and going strong....u need ti find out resukts of biopsy first...i justr went for bone scan today and then CT scan next week..hopefully all is good there.....i am going to stanford tommorow to meet with top surgeon  and then going to UCSF to meet with radiologist that does brachytheropy....if they say the 10 and 15 year survival rate ar about the same for both procedures for as well as the cure rate..well its a no brainer,.,,my new doc was very frank with me...sure he will cut it out and we will be done with it..buttt i wont have a dick anymore  he doent care what anyone says..your erection will never be the same if any  as well as maybe sone incontinenece  and losing size....so why would you want that if u dont need it  and he said I dont and for now i believe him....i will let  u know what stanford  and UCSF have to say my friend ..very stressfulllllll thats for sure  but apparantly  there are other alternatives in the beginnign stages..i guess it depends on the dr u have  and if they care about you or making money i ahve found out

MK1965
Posts: 162
Joined: Jun 2016

Steve,

I totaly agree with you. Surgery should be last resort not the first option.

All what you mentioned in your post, I experienced on my own skin during my 14 1/2months after having RP.

I had RP at the age of 51 and this surgery ruined not just my sex life but  life in general.

I am glad you see all possible dangers of prostate removal and loss of QoL after surgery.

You are very lucky guy to run into such humanly understanding urologist who advised you against Surgery.

For us, who made mistakes selecting surgery, is no way back. Damage is done. Suffering in every aspect of life is what is left.

And just to mention: Penile rehab is extremely expensive. Insurance does not cover anything after surgery.

I already spent lots of money.

Good luck with your choice a wish you best possible outcome.

MK

Old Salt
Posts: 720
Joined: Aug 2014

Any surgeon wih over 1000 prostates 'snatched' is well qualified. Comparing numbers over that is rather pointless. Other factors become relevant (margins, side effects, use of assistants etc.) Unfortunately, those other factors may be hard to come by.

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Late to this thread but this is my standard post to newbies on the topic.  Hope you find it useful, OP.

Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cncer is considered "low risk", he has time to decide which choice is best for him.  So, the first thing a new prostate cancer patient should do is to do research on the available options before he actually has to make the decision regarding which treatment to choose.

The following is my response to other men who asked for similiar advice about the treatment choices avilable to them.  It's a summary of the available treatment options and my personal opinion on the matter.   You can, of course, ignore my opinion about which treatment choice I think is best.  The overview of the choices is still otherwise valid.

 . . .  People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 7 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of the treatment options that you need to consider:

1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist actually had the to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

5) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

Good luck!

 

Steve1961
Posts: 199
Joined: Dec 2017

i just did the comparison  and for my situation and it looks like the best outcome is HDR..so there you are

Steve1961
Posts: 199
Joined: Dec 2017

dont know if i agree with open Vs robotic....granted is u choose robotic u need to find  surgeon taht has done over 1000...robotic causes less trama bleeding more accuracy..everything inside u is magnified 5 to 10 times more than the naked eye can see..i heard u do lose about .5 to an 1 inch not 2  and recovery time is much faster  that is why i am hearing that open is almost a thing of the past......just saying  though it is still very invasive and should be the last option ..i have had to veteran surgeon  one who makes money off doing it tell me i dont need it

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3225
Joined: May 2012

grahambda,

I read your link from the Prostate Cancer Free Foundation (PCFF) that compiled the results....thank you.  Folks here routinely complain that, when a surgeon recommends R.P. it is because of "bias."   Given that common observation, I submit the following for your consideration.

The first two questions to ask before reading any study on any subject are:(1) Who wrote it? and (2) Who paid for it ?

The Founder of PCFF, Dr. Peter Grimm, is a radiation oncologist.

On the site's Study Group, which is presumably who submits papers, there are 36 doctors.  Their specialty breakdown, from the site itself, is as follows:  

28 are Radiation Oncologist  (!!).   Of these, while some are cross-trained in medical oncology, most have spent most of their careers in R.O.  Most have been department heads of radiation oncology or similiar positions of prominence.

Four or five from The Group are trained in surgery, but most of these use surgery to perform Brachytherapy. In effect, they too are radiation oncologists in practice.

A very high percentage of the Group overall states specialization in Brachytherapy generally. One (Dr. Merrick) is past President of the American Brachytherapy Society.  Dr. Jeremy Millar is "head of brachytherapy services" at Alfred Health.

About four doctors in The Group could not be identified as to career specialty with the data provided on the site, except for being oncologists and researchers.  I could not identify one (1) member who is straightforwardly focused on R.P.

I do not doubt that every one of these doctors is stellar, and a leader in curing PCa.   But the composition of the Group as a whole screams "Radiation Cheering Section !"

You say the results are "surprising."  Hardly so.

max

 

Old Salt
Posts: 720
Joined: Aug 2014

For doing some serious homework, beyond the call of duty. You deserve an A+ for that post.

Steve1961
Posts: 199
Joined: Dec 2017

sorry i just looked at the donors and contributors  to the site  most of them are radiologist and one of them is Steven Kurtzman, M.D. OMG i couldnt believe it..i saw trhis guy for a consoltation what a complete A HOLE..this guy needs to be reported...he bad mouthed stanford  saying it is the worst palce any one shopuld ever go for surgery..he bad mouthed the surgeon i saw saying he isnt even an ocologist..he said he has done over 6000 brachtherapies..he said he can do it in 25 min utes blindfolded,, OMG what a********  he even dropped the f bomb in  front of my wife..the sacarey thing is people actually use this guy...sorry after seeing his name and seeing that radiation is at the top of aall treatments..i give this site ABSOLUTELY NOP CREDIBILITY AT ALL

hopeful and opt...
Posts: 2218
Joined: Apr 2009

I attended a lecture and spoke with Dr. Grimm before he passed away. He was a renown radiologist who did brachy. He was probably the very best in the world.  At the time, when I considered brachy, and believed if this became my treatment choice, I would travel to Seattle from So CA. where I live to have it done.  I believed Dr. Grimm to be highly ethical.

Of course most doctors from each specialty advocate their specialty.

 

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3225
Joined: May 2012

Hopeful and Optimistic,

I said what you wrote above:  I do not doubt that all are great, respected doctors, prominent in their field.  I have never met any of them, and also have never researched any of them.  My analysis was drawn completely from the PCFF website exclusively.

The website is a collection of radiation oncologists, mostly Brachytherapy guys, who now brag about how what they do is the best thing available in the world.  No shocker there.   They just need to stop pretending to be objective.   I would never grant any credibility to anything they published.  In the books I have read regarding PCa, Brachytherapy is not highly regarded, even among radiation oncologists themselves.

max

Clevelandguy
Posts: 415
Joined: Jun 2015

Hi All,

Have to agree with Max, seems kind of biased towards seeds.  I would feel better if it came from the American Cancer Society or another noted cancer center or college.

 

Dave 3+4

hopeful and opt...
Posts: 2218
Joined: Apr 2009

At various posts that you make at this board, you often quote from a book biased toward surgery, written by Patrick Walsh, a respected SURGEON from Johns Hopkins....Is that one of the  sources  that you just mentioned that desparages Brachytherapy?

Dr Grimm is to Brachy as DR. Walsh is to surgery.

Each professional , as you can realize drinks their own kool-aid.

I'm sure that there is information tnat is relevant from Dr. Walsh, as from Dr. Grimm in their writtings. 

We have to be informed to select what is relevant from each source.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3225
Joined: May 2012

hopeful and optimistic,

I have never read anything by a Dr. Patrick Walsh....never heard of him in fact.  I have also never read any book by anyone "biased toward surgery."

As I've stated twice above, I am sure that everyone at the PCFF is excellent.  Just don't assemble 36 radiation oncologists and then be surprised that what they find most effective is...radiation.   When doctors submit to professional journals, they are required to disclose any fiducary or professional links they have to the study or what it espouses.  It would be much more honest if people just stated their obvious orientation, that's all I recommend.

Actually, many times, I have stated that I do not buy in to the notion that doctors "recommend what they sell."  My view of MDs is higher than that.  Surgeons and radiation oncologists will all remain millionaires, regardless of what this or that patient decides.  The doctors I all spoke with were very charatible and generous in their assessments of treatments different than what they offered themselves, and I would suspect this to be true generally.  Personally, I have never stated dislike or low appreciation of RT, and in fact have more often recommended RT to men than RP.

Also, I never said that anyone I had read "disparaged" Brachytherapy, but rather that even many radiation oncologists find it less appealing than other forms of radiation.  Surgery was not part of their conculsions or even discussion.  I will dig up the reference for you,

 

 

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Sorry, I thought that it was you who always quote from Patrick Walsh's book. At any he wrote the book, " surviving prostate cancer", that I recommend, eventhough he is a urologist, and the book is somewhat slanted toward surgery (LOL)

https://www.google.com/search?authuser=0&ei=kWRyWuCmOtHIjwPl9b3ACA&q=patrick+walsh+md+johns+hopkins+books&oq=patrick+walsh+md+johns+hopkins%2C+book&gs_l=psy-ab.1.1.33i21k1j33i160k1l2.26504.27803.0.31061.6.6.0.0.0.0.149.710.1j5.6.0....0...1.1.64.psy-ab..0.6.707...0i22i30k1.0.kf0OByktWFQ

 

 

Subscribe to Comments for "Good site compares PC treatments - surprising results"