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Combining Imaging Techniques Could Enable Surgical Removal of Prostate Cancer Without Biopsy

By MedImaging International staff writers
Posted on 15 Nov 2024

Prostate cancer (PCa) is one of the most prevalent cancers in men. More...

Traditionally, PCa is diagnosed through biopsy, where a small tissue sample is collected from the affected area using imaging methods, such as ultrasonography. However, ultrasound-guided prostate biopsy has poor sensitivity, often leading to the detection of clinically insignificant PCa. Moreover, the use of transrectal ultrasound-guided prostate biopsy can be costly and comes with risks, such as urinary tract infections. A biopsy is usually required before recommending radical prostatectomy (RP), a common surgical procedure to remove the prostate gland in PCa patients.

To address these challenges, researchers are working on alternatives that could eliminate the need for biopsy prior to RP. Imaging techniques like multiparametric magnetic resonance imaging (mpMRI), which uses magnetic fields and radio waves, and prostate-specific membrane antigen positron emission tomography (PSMA PET) combined with computed tomography (CT), which uses radioactive tracers and X-ray imaging, have proven diagnostic value for PCa. In PSMA PET/CT, the presence of cancer is assessed based on the maximum standardized uptake value (SUVmax), indicating the amount of radioactive tracer absorbed by cancer cells. Previous studies have shown that combining PSMA PET/CT with MRI can reduce the likelihood of missing clinically significant PCa cases (false negatives)

Building on these findings, researchers from the Chinese Academy of Medical Sciences (Beijing, China) investigated whether PSMA PET/CT combined with MRI could help patients with suspected PCa avoid biopsy prior to undergoing RP. The study included 56 patients with PCa who had RP without a preoperative biopsy, recruited from two tertiary hospitals between December 2017 and April 2022. The agreement between clinical diagnoses and pathological findings was evaluated. Patients with elevated prostate-specific antigen levels or abnormal results from a digital rectal examination were recommended to undergo mpMRI. Positive mpMRI results were defined as having a Prostate Imaging Reporting and Data System (PI-RADS) score of 4 or higher. Similarly, PSMA PET/CT results were considered positive when the SUVmax value was 4 or greater. Only patients with elevated prostate-specific antigen levels, positive mpMRI results, and positive PSMA PET/CT findings, who opted not to have a biopsy, were considered for the biopsy-free approach.

Among the 56 patients who underwent RP, pathological analysis confirmed PCa in 55 cases, with 49 of these patients diagnosed with clinically significant PCa. One case was misdiagnosed as high-grade prostatic intraepithelial neoplasia (HGPIN). The prostate-specific antigen levels and SUVmax values in patients with clinically significant PCa were higher than in those with clinically insignificant PCa or HGPIN. Additionally, the median prostate volume was lower in patients with clinically significant PCa. Extracapsular extension was accurately detected in 21 of 26 patients, while five patients were mistakenly classified as having localized disease. When the SUVmax cutoff was raised to 7.5 or higher, PSMA PET/CT's diagnostic accuracy for clinically significant PCa reached 100%. These results, published in the Chinese Medical Journal, suggest that combining PSMA PET/CT with MRI could enable a biopsy-free approach to RP in patients with PCa.

“This diagnostic technique is a boon for patients to decrease the medical costs and hospitalization duration and avoid complications associated with biopsy,” said Dr. Nianzeng Xing from the Chinese Academy of Medical Sciences who led the study.

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58 (!!!!! 2490.9973144531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

59 (!!!!! 7942.9149627686): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

60 (!!!!! 2996.9215393066): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

61 (!!!!! 10373.115539551): SELECT fid FROM jos_deeppockets WHERE id=294803141 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294803141 AND published='1' LIMIT 1

62 (!!!!! 2336.0252380371): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

63 (!!!!! 2046.1082458496): select jos_twitters.link from jos_twitters where cat=10

64 (!!!!! 7161.1404418945): select jos_facebook.link from jos_facebook where cat=10

65 (!!!!! 7912.8742218018): select jos_google_plus.link from jos_google_plus where cat=10

66 (!!!!! 7915.0199890137): select jos_linkedin.link from jos_linkedin where cat=10

67 (!!!!! 7637.9776000977): SELECT fid FROM jos_deeppockets WHERE id=294803141 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294803141 AND published='1' LIMIT 1

68 (!!!!! 7642.0307159424): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=215 ORDER BY `ordering`

69 (!!!!! 7730.0071716309): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294803141 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

70 (!!!!! 7899.0459442139): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

71 (122.0703125): SELECT show_live FROM jos_com_show_setting LIMIT 1

72 (!!!!! 8217.0963287354): SELECT show_live FROM jos_com_show_setting LIMIT 1

73 (!!!!! 3799.9153137207): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (628.94821166992): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (!!!!! 1042.8428649902): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (50.783157348633): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (53.882598876953): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (103.95050048828): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294803141 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

86 (61.03515625): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

87 (56.982040405273): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (113.96408081055): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (!!!!! 5931.1389923096): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (272.03559875488): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (126.12342834473): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (295.87745666504): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (49.114227294922): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (458.95576477051): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (418.90144348145): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

102 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

103 (107.0499420166): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294803141 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

104 (230.07392883301): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

105 (63.180923461914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

106 (369.07196044922): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294803141 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294803135 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (283.95652770996): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294803135 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (823.974609375): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

110 (526.90505981445): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

111 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

112 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

113 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

114 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

115 (99.18212890625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

116 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

117 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

118 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

119 (406.02684020996): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

120 (!!!!! 75635.91003418): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

121 (645.87593078613): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294803141 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294803141 AND type='deeppockets_item' AND published='1' LIMIT 1

122 (!!!!! 30771.017074585): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

123 (151.15737915039): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

124 (347.85270690918): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

125 (!!!!! 1622.9152679443): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

126 (78.916549682617): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

127 (32.901763916016): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

128 (338.07754516602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

129 (51.975250244141): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

130 (39.100646972656): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

131 (29.802322387695): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

132 (651.12113952637): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

133 (!!!!! 2623.0812072754): SELECT name FROM jos_deeppockets WHERE id=215

134 (119.92454528809): SELECT name FROM jos_deeppockets WHERE id=215

135 (752.92587280273): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

136 (!!!!! 11137.008666992): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))215((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

137 (!!!!! 8960.9622955322): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

138 (!!!!! 10836.124420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

139 (!!!!! 15619.993209839): TRUNCATE TABLE jos_trademed_module

140 (!!!!! 7062.9119873047): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294803141 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

141 (!!!!! 5855.0834655762): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

142 (!!!!! 8687.0193481445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

143 (!!!!! 7647.0375061035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

144 (!!!!! 11911.869049072): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

145 (!!!!! 7345.9148406982): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

146 (!!!!! 7790.0886535645): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

147 (!!!!! 7953.8822174072): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

148 (!!!!! 7783.8897705078): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294803141 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294803141 AND type='deeppockets_item' AND published='1' LIMIT 1

149 (!!!!! 7881.1645507812): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

150 (!!!!! 8018.0168151855): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=0 or channel_id is null)

151 (!!!!! 7621.0498809814): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

152 (!!!!! 7518.0530548096): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

153 (!!!!! 5553.0071258545): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294803141 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294803141 AND published='1' LIMIT 1

154 (!!!!! 11760.950088501): select jos_twitters.link from jos_twitters where cat=10

155 (!!!!! 7973.9093780518): select jos_facebook.link from jos_facebook where cat=10

156 (!!!!! 11909.961700439): select jos_google_plus.link from jos_google_plus where cat=10

157 (!!!!! 7911.9205474854): select jos_linkedin.link from jos_linkedin where cat=10

158 (!!!!! 15632.86781311): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14202,14203)

159 (!!!!! 4641.056060791): insert into jos_banners_delta values (14202,'2025-08-01 22:19:50','216.73.216.210','view'),(14203,'2025-08-01 22:19:50','216.73.216.210','view')

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