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Risk of Nerve Damage in Prostate Cancer Surgeries Reduced by Preop MRI

By MedImaging International staff writers
Posted on 08 Feb 2012

Preoperative magnetic resonance imaging (MRI) helps surgeons make more informed choices about nerve-sparing procedures in men with prostate cancer, according to a new study.

The study’s findings were published online January 25, 2012, in the journal Radiology. Excluding skin cancer, prostate cancer is the most common cancer diagnosed in men in the United States, according to the Centers for Disease Control and Prevention (Atlanta, GA, USA). Open radical prostatectomy (removal of the prostate) is a common treatment for the disease, but it carries considerable risks, including impotence and incontinence.

“I think preoperative MRI will be useful for surgeons who are uncertain whether to spare or resect the nerves,” said Daniel J. A. Margolis, MD, assistant professor of radiology at the David Geffen School of Medicine at the University of California Los Angeles (USA). “Our surgeons feel that, compared with clinical information alone, MRI is worthwhile for all patients, because it identifies important information leading to a change in the surgical plan in almost a third of patients.”

Robotic-assisted laparoscopic prostatectomy (RALP) is a newer treatment performed with the assistance of a surgical robot. RALP uses smaller incisions than those of open radical prostatectomy and offers improved cosmetic results, less blood loss and briefer postoperative convalescence. However, surgeons performing RALP lack tactile feedback, which may compromise their ability to evaluate neurovascular bundles--the groups of blood vessels and nerves that course alongside prostate. An aggressive surgical approach could unnecessarily damage the bundles and leave patients with loss of function, while an approach that is not aggressive enough may leave some cancer behind. There are no conventional preoperative urological techniques that provide information to take the place of tactile feedback.

Dr. Margolis and colleagues investigated endorectal coil MR imaging as a way to improve preoperative assessment of prostate cancer and the involvement of the neurovascular bundles. They prospectively evaluated 104 prostate cancer patients who underwent preoperative endorectal coil MRI of the prostate and subsequent RALP. The researchers determined the differences in the surgical plan before and after review of the MRI report and compared them with the actual surgical and pathologic results.

Preoperative prostate MRI data changed the decision to use a nerve-sparing technique during RALP in 28 (27 %) of the 104 patients. The surgical plan was changed to the nerve-sparing technique in 17 (61%) of the 28 patients and to a non-nerve-sparing technique in 11 patients (39%). The decision to opt for nerve-sparing surgery did not compromise oncologic outcome.

Dr. Margolis cautioned that the study group represented a population of men with low to medium grade cancer and that the findings might not be applicable to all patients. “There is a learning curve for prostate MRI,” Dr. Margolis said. “What we and others have found is that one has to select patients where there is likely to be a benefit from the imaging.”

For the approach to become more routine, Dr. Margolis noted that that two things were needed: a better way to stratify which patients would benefit from preoperative MRI, and a more standardized way of acquiring and interpreting prostate MRI results. “The former is something we are investigating now,” Dr. Margolis concluded. “The latter is something that a number of leading experts in prostate MRI are working toward. However, most centers already have this technology, so this may become widespread relatively soon.”

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60 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

61 (101.08947753906): 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

62 (522.13668823242): SELECT fid FROM jos_deeppockets WHERE id=294739212 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739212 AND published='1' LIMIT 1

63 (323.05717468262): 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=212 ORDER BY `ordering`

64 (44.107437133789): select jos_twitters.link from jos_twitters where cat=10

65 (27.894973754883): select jos_facebook.link from jos_facebook where cat=10

66 (30.040740966797): select jos_google_plus.link from jos_google_plus where cat=10

67 (32.901763916016): select jos_linkedin.link from jos_linkedin where cat=10

68 (41.961669921875): SELECT fid FROM jos_deeppockets WHERE id=294739212 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294739212 AND published='1' LIMIT 1

69 (33.140182495117): 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=212 ORDER BY `ordering`

70 (282.04917907715): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (246.04797363281): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.815902709961): 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`

73 (55.789947509766): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (47.922134399414): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.040740966797): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (32.901763916016): 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`

90 (66.041946411133): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

105 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

106 (70.095062255859): 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=294739212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (49.829483032227): 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.cat=10 AND dp.id=294739212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

109 (57.93571472168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

110 (53.882598876953): 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=294739212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (697.85118103027): 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=294739212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (710.96420288086): 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

113 (509.97734069824): 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

114 (162.12463378906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

115 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

116 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

117 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

118 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

119 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

120 (77.962875366211): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

122 (313.99726867676): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 24420.022964478): 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

124 (461.10153198242): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739212 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739212 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8750.9155273438): ( 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

126 (95.129013061523): ( 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

127 (90.122222900391): 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

128 (42.915344238281): 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

129 (73.909759521484): 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

130 (46.014785766602): 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

131 (439.88227844238): 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

132 (133.03756713867): 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

133 (92.983245849609): 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

134 (58.174133300781): 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

135 (510.93101501465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 5882.0247650146): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (494.00329589844): SELECT name FROM jos_deeppockets WHERE id=212

138 (46.014785766602): SELECT name FROM jos_deeppockets WHERE id=212

139 (811.10000610352): 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 '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (698.08959960938): 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 '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

142 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

143 (!!!!! 18803.834915161): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 1287.9371643066): 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=294739212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (84.877014160156): 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.cat=10 AND dp.id=294739212 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (325.20294189453): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (157.11784362793): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 1747.8466033936): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

149 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

150 (!!!!! 1612.9016876221): 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

151 (95.129013061523): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

152 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

153 (64.13459777832): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294739212 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294739212 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (46.014785766602): 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=212 or channel_id is null)

155 (38.14697265625): 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=212 or channel_id is null)

156 (38.14697265625): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

158 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294739212 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294739212 AND published='1' LIMIT 1

159 (151.8726348877): select jos_twitters.link from jos_twitters where cat=10

160 (334.9781036377): select jos_facebook.link from jos_facebook where cat=10

161 (163.79356384277): select jos_google_plus.link from jos_google_plus where cat=10

162 (199.0795135498): select jos_linkedin.link from jos_linkedin where cat=10

163 (522.13668823242): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 1744.0319061279): insert into jos_banners_delta values (14615,'2025-06-26 15:10:31','216.73.216.249','view'),(14202,'2025-06-26 15:10:31','216.73.216.249','view'),(14203,'2025-06-26 15:10:31','216.73.216.249','view')

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