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Experts Discuss Emerging Treatments and Multidisciplinary Approaches to Prostate Cancer Care

By MedImaging International staff writers
Posted on 16 Jun 2011

Urologists and radiation oncologists might serve prostate cancer patients better if they collaborated on multidisciplinary approaches to treatment, instead of adopting an "either/or" perspective that frequently results in a choice between surgery, brachytherapy, external beam radiotherapy, or stereotactic ablative body radiotherapy (SABR), a noninvasive alternative to surgical intervention, according to leading clinical experts.

The findings were presented in the Varian Medical Systems (Palo Alto, CA, USA) booth at the American Urological Association (AUA) meeting in Washington DC (USA) in May 2011. "The development of stereotactic radiosurgery capabilities has opened up new possibilities for the noninvasive treatment of kidney and prostate cancer," said Lee E. Ponsky, MD, director of the Center for Urologic Oncology and Minimally Invasive Therapies at University Hospitals Case Medical Center (Cleveland, OH, USA). "Urologists and surgeons need to be aware of these developments, and work closely with colleagues in radiation oncology to evaluate the role of radiosurgery in the treatment of prostate and kidney cancer."

Dr. Ponsky discussed several preclinical and clinical trials taking place at his institution, looking at the viability of radiosurgery for treating small renal masses (kidney cancer), as well as early stage prostate cancer. "We have now treated about 20 kidney, and over 60 prostate cancer patients. We have reason to be cautiously optimistic. There have been no adverse events among the kidney cancer patients related to treatment. The initial data from the prostate cancer trial look promising. Patients received five treatments, initially on consecutive days; now we spread this out to treat every other day. We're seeing minimal side effects and an encouraging PSA [prostate-specific antigen] response in these early trials," he said.

Constantine A. Mantz, MD, chief medical officer at 21st Century Oncology (Fort Myers, FL, USA) presented on SABR as an emerging treatment for prostate cancer. Dr. Mantz has been conducting phase II trials using Varian's Trilogy machine to deliver SABR treatments for early stage prostate cancer, and has presented on the effectiveness and safety of this approach at international medical meetings.

"We're finding that SABR may enable improved outcomes while maintaining, if not further reducing, the already-low complication rates that we have been seeing with earlier advances like intensity modulation and image-guidance," Dr. Mantz said. "For our SABR treatments, we use imaging and beam-shaping technology in a way that allows us to compress the typical two-month course of radiation therapy down to only five visits over a two-week period."

John Ravera, MD, research director at the Cancer Center of Irvine (CA, USA), discussed the use of hybrid prostate radiation therapy (HPRT), which combines the use of high-dose-rate brachytherapy with image-guided radiotherapy (IGRT), which targets the tumor with high-energy X-rays delivered from outside the body. "HPRT is best managed through a close collaboration between urologists and radiation oncologists," Dr. Ravera said.

Historically, clinicians at the Cancer Center of Irvine had been using permanent seed implants to treat prostate cancer, so they were used to close collaboration with urologists. "Our cancer center is right next to the surgical center," Dr. Ravera said. "We've always collaborated; urologists helped us place the seeds for low-dose-rate brachytherapy. More recently, we worked together to test an interesting procedure for reducing rectal bleeding and diarrhea, which are the most common side effects from radiotherapy for prostate cancer."

Dr. Ravera and his colleagues evaluated a physical spacer for separating the prostate from the rectum during radiotherapy treatment. "We completed an FDA [US Food and Drug Administration]-approved study of ten patients, using a cross-linked hyaluronan gel that we injected between the prostate and rectum. Once injected, the gel would solidify and move the rectum away from the prostate. We didn't need much separation because IGRT is a very precise way of delivering dose. Less than a centimeter of space between the two organs enabled us to reduce the amount of incidental dose reaching the rectum. For these men, we saw a significant decrease in rectal side effects."

"As radiation oncology continues to evolve and technology developments blur the distinction between surgical and nonsurgical interventions, we think that multidisciplinary care will become more and more the norm," said Calvin Huntzinger, MS, senior director, Varian Surgical Sciences. "Varian is committed to helping facilitate this teamwork so that the benefits of noninvasive radiosurgery can be made available to more patients."

Related Links:
Varian Medical Systems
Center for Urologic Oncology and Minimally Invasive Therapies at University Hospitals Case Medical Center
21st Century Oncology

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58 (81.062316894531): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

59 (112.05673217773): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

60 (47.206878662109): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

61 (106.0962677002): 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 (524.04403686523): SELECT fid FROM jos_deeppockets WHERE id=294735612 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735612 AND published='1' LIMIT 1

63 (319.9577331543): 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`

64 (50.067901611328): select jos_twitters.link from jos_twitters where cat=10

65 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

66 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

67 (28.848648071289): select jos_linkedin.link from jos_linkedin where cat=10

68 (31.948089599609): SELECT fid FROM jos_deeppockets WHERE id=294735612 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294735612 AND published='1' LIMIT 1

69 (46.014785766602): 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`

70 (302.07633972168): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (261.06834411621): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (96.08268737793): 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 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (50.783157348633): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735612 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=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (36.001205444336): 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 (54.836273193359): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): 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 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (76.055526733398): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

105 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

106 (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.cat=10 AND dp.id=294735612 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (47.922134399414): 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=294735612 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

109 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

110 (49.114227294922): 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=294735612 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (625.1335144043): 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=294735612 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (818.01414489746): 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 (570.05882263184): 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 (211.00044250488): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

115 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

116 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

117 (54.836273193359): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

118 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

119 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

120 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

121 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

122 (378.84712219238): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 21151.065826416): 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 (504.0168762207): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735612 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735612 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 7539.9875640869): ( 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 (77.009201049805): ( 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 (37.908554077148): 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 (30.040740966797): 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 (46.968460083008): 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 (28.848648071289): 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 (339.03121948242): 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 (44.107437133789): 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 (31.948089599609): 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 (29.087066650391): 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 (498.05641174316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (437.97492980957): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (288.00964355469): SELECT name FROM jos_deeppockets WHERE id=211

138 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=211

139 (629.90188598633): 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

140 (500.91743469238): 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

141 (80.108642578125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

142 (46.968460083008): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

143 (!!!!! 8978.1284332275): TRUNCATE TABLE jos_trademed_module

144 (162.83988952637): 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=294735612 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (117.06352233887): 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=294735612 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (739.09759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (89.883804321289): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (87.976455688477): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

149 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

150 (!!!!! 1624.1073608398): 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 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

152 (82.015991210938): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

153 (78.916549682617): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294735612 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294735612 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (59.843063354492): 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)

155 (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=211 or channel_id is null)

156 (71.048736572266): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (289.9169921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

158 (113.01040649414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294735612 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294735612 AND published='1' LIMIT 1

159 (63.180923461914): select jos_twitters.link from jos_twitters where cat=10

160 (36.954879760742): select jos_facebook.link from jos_facebook where cat=10

161 (33.140182495117): select jos_google_plus.link from jos_google_plus where cat=10

162 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

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