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First-Line PSA Testing More Cost-Effective Than First-Line MRI for Prostate Cancer Screening

By MedImaging International staff writers
Posted on 12 Jun 2024

Image: Screening for prostate cancer with first-line MRI is less cost-effective than first-line PSA testing (Photo courtesy of Adobe Stock)

Current prostate cancer (PCa) screening protocols typically begin with prostate-specific antigen (PSA) testing, which, if elevated, may lead to further assessment using multiparametric magnetic resonance imaging (mpMRI). Now, a cost-effectiveness analysis has revealed that using biparametric magnetic resonance imaging (bpMRI) as an initial screening tool is less cost-effective than the traditional approach of first-line PSA testing followed by mpMRI. This conclusion held true even when assuming no cost for bpMRI, indicating that the financial savings do not compensate for the drawbacks of using the first-line MRI approach.

A team of researchers from Fred Hutchinson Cancer Center (Seattle, WA, USA), in collaboration with other institutions, developed a microsimulation model to compare the effectiveness and cost-efficiency of first-line bpMRI versus first-line PSA with reflex mpMRI for prostate cancer screening. The study showed that initiating screening with MRI significantly increased the incidence of false positives, unnecessary prostate biopsies, and overdiagnoses, without a corresponding significant decrease in prostate cancer mortality. The findings suggest that even free bpMRI screening does not offer economic or quality-of-life advantages over the conventional approach of PSA testing followed by mpMRI and, if necessary, MRI-guided prostate biopsy supplemented by transrectal ultrasonography–guided biopsy.

These results underline the importance of focusing screening strategies on minimizing false positives and overdiagnoses to enhance cost-effectiveness. High-quality cost-effectiveness analyses like this are vital for understanding how changes in medical practice impact the broader healthcare system. Moreover, incorporating economic data from such analyses could strengthen the development of guidance statements, as endorsed by the National Comprehensive Cancer Network. It is recommended that other organizations also consider integrating cost-effectiveness information into their guidelines to inform clinical decisions.

Related Links:
Fred Hutchinson Cancer Center

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(!!!!! 2349.1382598877): SELECT id, title, module, position, content, showtitle, params
 FROM jos_modules AS m
 INNER JOIN jos_modules_menu AS mm ON mm.moduleid = m.id
 WHERE m.published = 1
 AND m.access <= 0
 AND m.client_id != 1
 AND ( mm.menuid = 0 OR mm.menuid = 294801517 )
 ORDER BY ordering38
(!!!!! 3926.0387420654): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 139
(!!!!! 3167.1524047852): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 140
(92.983245849609): SELECT
				*
			FROM
				jos_bannersmanager_banner
			WHERE
				`groupid` = 98
			AND
				`site_id` = 10
			AND
				`published` = 141
(275.1350402832): SELECT
				*
			FROM
				jos_bannersmanager_banner
			WHERE
				`groupid` = 99
			AND
				`site_id` = 10
			AND
				`published` = 142
(!!!!! 2099.9908447266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 143
(275.1350402832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 144
(!!!!! 4359.0068817139): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294801501

			LIMIT 145
(358.81996154785): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294801501

			LIMIT 146
(55.789947509766): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets_archive AS dp

			WHERE
				dp.id = 294801501

			LIMIT 147
(42.915344238281): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets_archive AS dp

			WHERE
				dp.id = 294801501

			LIMIT 148
(!!!!! 2522.9454040527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 149
(205.03997802734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 150
(!!!!! 1325.1304626465): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 151
(543.83277893066): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 152
(!!!!! 3614.9024963379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 153
(335.2165222168): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 154
(576.01928710938): SELECT name FROM jos_deeppockets WHERE id=294801517 LIMIT 155
(391.00646972656): SELECT name FROM jos_deeppockets_archive WHERE id=294801517 LIMIT 156
(989.91394042969): SELECT a.*
 FROM jos_components AS a
 WHERE ( a.admin_menu_link = 'option=com_syndicate' OR a.admin_menu_link = 'option=com_syndicate&hidemainmenu=1' )
 AND a.option = 'com_syndicate'57
(98.943710327148): 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=294801517
							AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
							AND dp.published='1' LIMIT 158
(859.97581481934): 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=294801517
								AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
								AND dp.published='1' LIMIT 159
(!!!!! 1700.8781433105): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 160
(92.983245849609): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 161
(190.97328186035): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 162
(78.201293945312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 163
(!!!!! 8332.0140838623): 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 164
(765.08522033691): SELECT fid FROM jos_deeppockets WHERE id=294801517 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294801517 AND published='1'  LIMIT 165
(63.896179199219): 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`66
(!!!!! 7258.8920593262): select jos_twitters.link from jos_twitters where cat=1067
(118.01719665527): select jos_facebook.link from jos_facebook where cat=1068
(49.114227294922): select jos_google_plus.link from jos_google_plus where cat=1069
(40.054321289062): select jos_linkedin.link from jos_linkedin where cat=1070
(71.048736572266): SELECT fid FROM jos_deeppockets WHERE id=294801517 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294801517 AND published='1'  LIMIT 171
(49.114227294922): 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`72
(558.13789367676): SELECT fid FROM jos_deeppockets
								WHERE cat=10
								AND id=294801517
								AND (type='deeppockets_item' OR type='deeppockets_item_link') 
								AND published='1' 
								LIMIT 173
(414.13307189941): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294801517 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 174
(86.069107055664): 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`75
(490.18859863281): SELECT show_live FROM jos_com_show_setting LIMIT 176
(77.009201049805): SELECT show_live FROM jos_com_show_setting LIMIT 177
(165.93933105469): SELECT show_live FROM jos_com_show_setting LIMIT 178
(41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 179
(!!!!! 2860.0692749023): SELECT show_live FROM jos_com_show_setting LIMIT 180
(92.029571533203): SELECT show_live FROM jos_com_show_setting LIMIT 181
(327.11029052734): SELECT show_live FROM jos_com_show_setting LIMIT 182
(46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 183
(247.00164794922): SELECT show_live FROM jos_com_show_setting LIMIT 184
(42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 185
(173.09188842773): SELECT show_live FROM jos_com_show_setting LIMIT 186
(41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 187
(137.0906829834): SELECT show_live FROM jos_com_show_setting LIMIT 188
(40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 189
(!!!!! 2359.15184021): SELECT fid FROM jos_deeppockets
								WHERE cat=10
								AND id=294801517
								AND (type='deeppockets_item' OR type='deeppockets_item_link') 
								AND published='1' 
								LIMIT 190
(55.074691772461): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294801517 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 191
(50.067901611328): 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`92
(82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 193
(41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 194
(41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 195
(36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 196
(46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 197
(!!!!! 1632.9288482666): SELECT show_live FROM jos_com_show_setting LIMIT 198
(79.870223999023): SELECT show_live FROM jos_com_show_setting LIMIT 199
(41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1100
(39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1101
(37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1102
(39.100646972656): SELECT show_live FROM jos_com_show_setting LIMIT 1103
(36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1104
(43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1105
(38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1106
(!!!!! 6928.9207458496): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1107
(!!!!! 6774.90234375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1108
(120.87821960449): 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=294801517
							AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
							AND dp.published='1' LIMIT 1109
(675.20141601562): 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=294801517
								AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
								AND dp.published='1' LIMIT 1110
(!!!!! 5317.9264068604): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1111
(162.12463378906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1112
(806.09321594238): 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=294801517
							AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
							AND dp.published='1' LIMIT 1113
(!!!!! 3886.9380950928): 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=294801517
								AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
								AND dp.published='1' LIMIT 1114
(149.96528625488): 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=294801501
							AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
							AND dp.published='1' LIMIT 1115
(781.05926513672): 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=294801501
								AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
								AND dp.published='1' LIMIT 1116
(!!!!! 2510.0708007812): 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 1117
(859.97581481934): 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 1118
(272.98927307129): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1119
(71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1120
(!!!!! 1786.9472503662): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1121
(216.00723266602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1122
(622.98774719238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1123
(69.856643676758): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1124
(!!!!! 1307.0106506348): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1125
(480.89027404785): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1126
(494.00329589844): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`127
(!!!!! 64172.029495239): 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
				7128
(816.10679626465): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294801517 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294801517 AND type='deeppockets_item' AND published='1'  LIMIT 1129
(!!!!! 26679.992675781): (
				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
				3130
(82.015991210938): (
				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
				3131
(547.88589477539): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294803337

			LIMIT 1132
(!!!!! 2998.1136322021): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294803337

			LIMIT 1133
(829.93507385254): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294803276

			LIMIT 1134
(162.12463378906): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294803276

			LIMIT 1135
(575.06561279297): 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 1136
(161.88621520996): 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 1137
(612.02049255371): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294802958

			LIMIT 1138
(80.108642578125): SELECT
				dp.id,
				dp.name,
				dp.title,
				dp.video,
				dp.video_source,
				dp.created

			FROM
				jos_deeppockets AS dp

			WHERE
				dp.id = 294802958

			LIMIT 1139
(!!!!! 1287.9371643066): SELECT *
                            FROM jos_deeppockets
                            WHERE 1=1 
                              AND id=294801517
                              AND (type='deeppockets_item' OR type='deeppockets_item_link')
                              AND published='1'
                            LIMIT 1140
(885.009765625): SELECT *
                            FROM jos_deeppockets_archive
                            WHERE 1=1 
                              AND id=294801517
                              AND (type='deeppockets_item' OR type='deeppockets_item_link')
                              AND published='1'
                            LIMIT 1141
(392.91381835938): SELECT name FROM jos_deeppockets WHERE id=212142
(931.97822570801): SELECT name FROM jos_deeppockets WHERE id=212143
(!!!!! 1629.114151001): 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((;)|($))' AND catid IN (0,110) 
    ORDER BY publish_up ASC LIMIT 3144
(971.07887268066): SELECT *,
    DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up,
    DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down
    FROM jos_events
    WHERE state=1
    AND publish_up > NOW()
    and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) 
    ORDER BY publish_up ASC LIMIT 3145
(!!!!! 5660.0570678711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1146
(!!!!! 3869.0567016602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1147
(!!!!! 12587.070465088): TRUNCATE TABLE jos_trademed_module148
(!!!!! 3051.0425567627): 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=294801517
							AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
							AND dp.published='1' LIMIT 1149
(!!!!! 3081.0832977295): 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=294801517
								AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link')
								AND dp.published='1' LIMIT 1150
(!!!!! 1406.9080352783): SELECT *
   FROM jos_deeppockets
   WHERE 1=1 
   AND id=294801517
   AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1151
(82.969665527344): SELECT *
   FROM jos_deeppockets
   WHERE 1=1 
   AND id=294801517
   AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1152
(995.87440490723): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1153
(74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1154
(!!!!! 2893.9247131348): 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 6155
(461.10153198242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1156
(253.91578674316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1157
(!!!!! 11392.116546631): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294801517 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294801517 AND type='deeppockets_item' AND published='1'  LIMIT 1158
(!!!!! 8087.8734588623): 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)159
(!!!!! 8333.9214324951): 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)160
(!!!!! 7394.7906494141): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1161
(!!!!! 5455.0170898438): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1162
(!!!!! 6307.84034729): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294801517 AND published='1'
				union
		SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294801517 AND published='1'
		LIMIT 1163
(154.01840209961): select jos_twitters.link from jos_twitters where cat=10164
(!!!!! 12917.995452881): select jos_facebook.link from jos_facebook where cat=10165
(!!!!! 7941.9612884521): select jos_google_plus.link from jos_google_plus where cat=10166
(!!!!! 7910.9668731689): select jos_linkedin.link from jos_linkedin where cat=10167
(!!!!! 7627.9640197754): update jos_bannersmanager_banner
			set impmade=impmade+1
			where id in(14615,14202,14203)168
(!!!!! 10229.825973511): insert into jos_banners_delta values (14615,'2025-08-02 02:59:11','216.73.216.210','view'),(14202,'2025-08-02 02:59:11','216.73.216.210','view'),(14203,'2025-08-02 02:59:11','216.73.216.210','view')

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