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Frequent CT Scanning for Testicular Cancer Linked to Secondary Malignancies

By MedImaging International staff writers
Posted on 14 Apr 2011

Cancer researchers have found that older men with early-stage testicular cancer who opt for surveillance with regular computed tomography (CT) scans over lymph node removal are at greater risk for secondary cancers. More...

The findings, published online March 21, 2011, in the journal Cancer, indicate that physicians should consider the risk of new cancers with surveillance when discussing treatment options with their patients.

Along with a multidisciplinary team of researchers, Dr. Karim Chamie, a University of California (UC) Davis (USA) urology resident at the time of the study, examined the cases of 7,301 men diagnosed between 1988 and 2006 with nonseminomatous germ cell tumor, the most common type of testicular cancer. Dr. Chamie and his colleagues sought to find out if, after initial surgery, frequent CT imaging of men to look for new signs of the disease increased the rate of secondary tumor growth.

"This is the first study that I am aware of that shows that diagnostic CT scans cause cancer with statistical significance,” said Dr. John Boone, professor in the department of radiology at UC Davis, study coauthor and internationally known CT expert. "The organizations that recommend these protocols need to reevaluate this aggressive use of CT and maybe opt for MRI or ultrasound.”

Dr. Chamie explained that men with stage-one testicular cancer are typically offered three choices of treatment after removal of a cancerous testicle: two doses of chemotherapy, lymph node dissection, or "active surveillance,” which requires frequent CT scans.

According to the investigators, in the 1980s active surveillance emerged as an attractive alternative to surgical removal of the retroperitoneal lymph nodes or chemotherapy in men with early-stage testicular cancer. Dr. Chamie, now a urology fellow at University of California, Los Angeles (UCLA), noted that the surveillance choice is particularly popular among younger men, who fear the potential side effects of aggressive surgery or chemotherapy such as ejaculatory dysfunction, bowel adhesions, neuropathy, and other problems.

In the 1990s, nearly half of patients diagnosed with early-stage disease were treated with orchiectomy (testicle removal) alone. For those patients, the US National Comprehensive Cancer Network Guidelines recommend a total of 15 CT scans in the first five years after surgery (every two to three months for the first year, then tapering off each consecutive year) to check for new signs of disease. After four years, CT scans are recommended just once annually.

Excessive CT scanning has been the topic of considerable debate in recent years; as the technology has become better at detecting disease, it has been used with far more frequency, exposing more people to ionizing radiation, which can cause cancer at high doses. "What has happened is that because CT images are so diagnostically useful, physicians request them for their patients in great numbers, so the concerns are really based upon the fact that 80 million CT scans are performed every year in the US,” said Dr. Boone. "That is a huge number.”

Dr. Boone added that active surveillance protocols are one example where a large number of repeat CT scans are performed on a patient. "It should be emphasized that this study involved patients who had 15 or more CT scans, not one or two,” he said.

Dr. Chamie's research revealed that more patients who have been on active surveillance will be diagnosed with secondary malignancies after 15 years than will patients who received aggressive lymph node surgery or chemotherapy. Statistical analysis determined that of 10,000 patients put on active surveillance, 306 would get secondary malignancies, versus 233 if they had the surgery alone. That translates into 73 additional secondary malignancies. Moreover, whereas 73 may not seem like a big number, of the men who underwent surgery, only 50 died of testicular cancer.

"The side effect is worse than the disease,” Dr. Chamie said. "More men are likely to get secondary malignancies than are liable to die from their active disease.” What amazed Dr. Chamie and the other researchers is that the risk of secondary tumors after repeated CT scans was more significant in older men than in younger men. Dr. Chamie suspects that is because younger bodies can more easily repair DNA damage caused by radiation exposure.

Dr. Chamie reported that 70% of patients with early-stage disease are cured after testicle-removal surgery, so for them, additional surgery to remove lymph nodes or chemotherapy would be unnecessary overtreatment. However, of those who opt only for active surveillance, 30% will go on to develop additional cancers that were not detected on CT scans. "So, do we sacrifice the 70%, or do we put 30% at risk of having progression and downstream effects of too many CT scans and chemotherapy? We need to do something other than active surveillance.”

Dr. Chamie stated that he hopes the findings lead to better ways to stratify patients in terms of who should be eligible for different treatment approaches, limiting active surveillance only to those men whose cancers are least likely to progress. Moreover, he suggested use of alternative imaging techniques, including ultrasound and magnetic resonance imaging (MRI), or less frequent use of CT imaging.

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57 (55.074691772461): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

58 (430.10711669922): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

59 (!!!!! 1706.1233520508): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

60 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

61 (226.97448730469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

62 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

63 (134.94491577148): 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

64 (703.81164550781): SELECT fid FROM jos_deeppockets WHERE id=294734528 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734528 AND published='1' LIMIT 1

65 (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=211 ORDER BY `ordering`

66 (73.909759521484): select jos_twitters.link from jos_twitters where cat=10

67 (41.961669921875): select jos_facebook.link from jos_facebook where cat=10

68 (74.863433837891): select jos_google_plus.link from jos_google_plus where cat=10

69 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

70 (56.982040405273): SELECT fid FROM jos_deeppockets WHERE id=294734528 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294734528 AND published='1' LIMIT 1

71 (42.915344238281): 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=211 ORDER BY `ordering`

72 (497.10273742676): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

73 (334.02442932129): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

74 (52.213668823242): 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 (79.154968261719): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (77.009201049805): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

90 (40.054321289062): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

91 (44.822692871094): 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 (76.055526733398): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (37.193298339844): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (104.18891906738): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

107 (62.942504882812): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

108 (77.009201049805): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

109 (66.041946411133): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

110 (107.0499420166): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

111 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

112 (112.05673217773): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

113 (730.99136352539): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

114 (808.9542388916): 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

115 (503.0632019043): 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

116 (160.93254089355): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

117 (120.87821960449): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

118 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

119 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

120 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

121 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

122 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

123 (52.213668823242): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

124 (391.96014404297): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 27778.86390686): 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

126 (670.9098815918): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734528 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734528 AND type='deeppockets_item' AND published='1' LIMIT 1

127 (!!!!! 9737.0147705078): ( 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

128 (174.04556274414): ( 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

129 (65.088272094727): 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

130 (40.769577026367): 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

131 (70.095062255859): 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

132 (39.100646972656): 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

133 (422.00088500977): 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

134 (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 = 294803276 LIMIT 1

135 (46.968460083008): 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

136 (36.954879760742): 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

137 (613.21258544922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (530.95817565918): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (54.121017456055): SELECT name FROM jos_deeppockets WHERE id=211

140 (74.863433837891): SELECT name FROM jos_deeppockets WHERE id=211

141 (780.82084655762): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (666.14151000977): 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 '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (91.791152954102): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

144 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

145 (!!!!! 10561.943054199): TRUNCATE TABLE jos_trademed_module

146 (148.05793762207): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (85.115432739258): 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=294734528 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (628.94821166992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

151 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

152 (!!!!! 1824.1405487061): 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

153 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

154 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

155 (56.028366088867): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294734528 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294734528 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (82.015991210938): 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=211 or channel_id is null)

157 (44.107437133789): 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=211 or channel_id is null)

158 (60.081481933594): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (216.00723266602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

160 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294734528 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294734528 AND published='1' LIMIT 1

161 (58.889389038086): select jos_twitters.link from jos_twitters where cat=10

162 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

163 (39.815902709961): select jos_google_plus.link from jos_google_plus where cat=10

164 (39.815902709961): select jos_linkedin.link from jos_linkedin where cat=10

165 (483.98971557617): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 1461.9827270508): insert into jos_banners_delta values (14615,'2025-08-20 05:38:51','216.73.216.0','view'),(14202,'2025-08-20 05:38:51','216.73.216.0','view'),(14203,'2025-08-20 05:38:51','216.73.216.0','view')

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