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Joint Guideline Issued for Radiation Therapy After Prostatectomy

By MedImaging International staff writers
Posted on 18 Jun 2013

A joint guideline on radiation therapy after prostatectomy for patients with and without evidence of prostate cancer recurrence has recently been published to provide patients with the best information on optimal outcomes.

The 81-page document, published jointly by the American Society for Radiation Oncology (ASTRO; Fairfax, VA, USA) and the American Urological Association (AUA; Linthicum, MD , USA), represents an intensive collaboration among experts in the radiation oncology and urology fields, led by Richard K. Valicenti, MD, MA, professor and chair of the department of radiation oncology at the University of California Davis Comprehensive Cancer Center (Sacramento, USA), on behalf of ASTRO, and Ian M. Thompson, MD, director of the Cancer Therapy and Research Center at the University of Texas Health Science Center (San Antonio, USA), on behalf of the AUA.

“The Adjuvant and Salvage Radiotherapy After Prostatectomy: ASTRO/AUA Guideline” is a comprehensive review of 324 research articles of English-language publications within the Embase, Pubmed, and Cochrane databases, published from January 1, 1990 through December 15, 2012. The guideline is available online free as a PDF document, and will be published in the August 1, 2013, print issue of the International Journal of Radiation Oncology • Biology • Physics (Red Journal), the official scientific journal of ASTRO, and in the August 2013 print issue of the Journal of Urology, the official journal of the AUA.

The strategies and approaches recommended were derived from evidence-based and consensus-based processes in the reviewed articles. The systematic review included articles that provided detailed efficacy in patients with detectable and undetectable prostate-specific antigen (PSA) levels, toxicity and quality of life impact, and optimal imaging strategies to determine the appropriateness of radiation therapy use in patients suspected of recurrence. Only studies in which PSA data were provided for 75% or more patients were included in the guideline.

The guideline document provides the following clinical principles, recommendations, standards, and options: (1) patients who are being considered for management of localized prostate cancer with radical prostatectomy should be informed of the potential for adverse pathologic findings that portend a higher risk of cancer recurrence; (2) patients with adverse pathologic findings including seminal vesicle invasion, positive surgical margins and extraprostatic extension should be informed that adjuvant radiation therapy, compared to radical prostatectomy only, reduces the risk of biochemical (PSA) recurrence, local recurrence and clinical progression of cancer; (3) physicians should offer adjuvant radiation therapy to patients with adverse pathologic findings at the time of prostatectomy, including positive surgical margin, seminal vesicle invasion, or extraprostatic extension because of demonstrated reductions in biochemical recurrence, local recurrence and clinical progression; (4) patients should be informed that the development of a PSA recurrence after surgery is associated with a higher risk of development of metastatic prostate cancer or death from the disease; (5) clinicians should define biochemical recurrence as a detectable or rising PSA value after surgery that is ≥ 0.2 ng/ml with a second confirmatory level ≥ 0.2 ng/ml; (6) a restaging assessment in the patient with a PSA recurrence may be considered; (7) physicians should offer salvage radiation therapy to patients with PSA or local recurrence after radical prostatectomy in whom there is no evidence of distant metastatic disease; (8) patients should be informed that the effectiveness of radiation therapy for PSA recurrence is greatest when given at lower levels of PSA; (8) lastly, patients should be informed of the possible short-term and long-term urinary, bowel, and sexual side effects of radiation therapy, as well as the potential benefits of controlling disease recurrence.

“This guideline explicitly includes a multitude of significant clinical trial results from more than 20 years of thorough research,” said Dr. Valicenti. “There is a critical need for evidence-based standards, recommendations, and options to maximize our ultimate goal of increased patient survival and quality of life. This guideline is a compendium of the vast wealth of research available and provides a thorough treatment template for us to consider for prostate cancer patients after a radical prostatectomy.”

The Guideline will serve as a new, organic platform of both specialties’ focus to optimal patient care and outcomes and will be updated regularly. “Many thanks to the dedicated efforts of Drs. Valicenti and Thompson for leading the extraordinary effort to issue this important document from both specialty organizations,” said Michael L. Steinberg, MD, FASTRO, chairman of ASTRO’s board of directors. “The Adjuvant and Salvage Radiotherapy after Prostatectomy: ASTRO/AUA Guideline is an essential tool for every practice as they determine the best treatment plan for prostate cancer patients after prostatectomy.”

Related Links:
American Society for Radiation Oncology
American Urological Association

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58 (!!!!! 28840.780258179): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

59 (745.05805969238): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

60 (797.03330993652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

61 (!!!!! 7473.2303619385): 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 (!!!!! 1063.8236999512): SELECT fid FROM jos_deeppockets WHERE id=294746819 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746819 AND published='1' LIMIT 1

63 (385.99967956543): 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 (!!!!! 1454.1149139404): select jos_twitters.link from jos_twitters where cat=10

65 (443.93539428711): select jos_facebook.link from jos_facebook where cat=10

66 (311.13624572754): select jos_google_plus.link from jos_google_plus where cat=10

67 (!!!!! 1121.997833252): select jos_linkedin.link from jos_linkedin where cat=10

68 (528.09715270996): SELECT fid FROM jos_deeppockets WHERE id=294746819 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294746819 AND published='1' LIMIT 1

69 (!!!!! 1044.0349578857): 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 (!!!!! 2158.8802337646): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (!!!!! 1493.9308166504): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (67.949295043945): 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 (!!!!! 1321.0773468018): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (267.02880859375): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (467.06199645996): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (184.05914306641): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (557.89947509766): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (203.84788513184): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (!!!!! 1064.0621185303): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (47.922134399414): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (372.88665771484): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (66.995620727539): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (268.93615722656): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 5911.8270874023): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (!!!!! 5218.9826965332): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (!!!!! 2122.163772583): 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 (!!!!! 13673.067092896): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 9208.9176177979): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (663.04206848145): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (202.89421081543): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (235.08071899414): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (398.87428283691): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (!!!!! 1893.9971923828): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (526.90505981445): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 2704.8587799072): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (661.13471984863): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (846.86279296875): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (245.09429931641): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (!!!!! 2815.9618377686): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (65.803527832031): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4809.1411590576): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

105 (144.00482177734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

106 (!!!!! 5453.1097412109): 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=294746819 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (!!!!! 16449.928283691): 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=294746819 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 3180.980682373): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

109 (!!!!! 2518.892288208): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

110 (!!!!! 7835.1497650146): 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=294746819 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (!!!!! 4652.9769897461): 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=294746819 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (!!!!! 3475.9044647217): 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 (!!!!! 5286.9319915771): 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 (!!!!! 2624.9885559082): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

115 (329.01763916016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

116 (!!!!! 7328.0334472656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

117 (!!!!! 7799.1485595703): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

118 (!!!!! 7586.0023498535): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

119 (!!!!! 8012.056350708): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

120 (!!!!! 7591.0091400146): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

121 (!!!!! 6294.9657440186): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

122 (609.8747253418): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 83238.124847412): 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 (!!!!! 1627.9220581055): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746819 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746819 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (99.18212890625): ( 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 (109.91096496582): ( 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 (92.983245849609): 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 (54.121017456055): 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 (!!!!! 2601.8619537354): 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 (107.0499420166): 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 (57.93571472168): 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 (46.968460083008): 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 (504.97055053711): 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 (68.187713623047): 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 (!!!!! 6613.9698028564): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (!!!!! 4175.9014129639): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (!!!!! 6972.7897644043): SELECT name FROM jos_deeppockets WHERE id=211

138 (!!!!! 6280.8990478516): SELECT name FROM jos_deeppockets WHERE id=211

139 (!!!!! 9114.9806976318): 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 (!!!!! 6899.1184234619): 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 (325.91819763184): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

142 (146.15058898926): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

143 (!!!!! 30829.906463623): TRUNCATE TABLE jos_trademed_module

144 (!!!!! 2043.9624786377): 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=294746819 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 9362.9360198975): 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=294746819 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (936.98501586914): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (689.98336791992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (!!!!! 2086.1625671387): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

149 (526.18980407715): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

150 (!!!!! 14330.148696899): 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 (!!!!! 3998.9948272705): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

152 (!!!!! 7143.0206298828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

153 (!!!!! 7705.2116394043): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294746819 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294746819 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (!!!!! 7903.0990600586): 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 (!!!!! 7979.154586792): 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 (!!!!! 7699.0127563477): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 7990.1218414307): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

158 (!!!!! 7861.852645874): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294746819 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294746819 AND published='1' LIMIT 1

159 (!!!!! 7677.0782470703): select jos_twitters.link from jos_twitters where cat=10

160 (!!!!! 7933.8550567627): select jos_facebook.link from jos_facebook where cat=10

161 (!!!!! 7933.8550567627): select jos_google_plus.link from jos_google_plus where cat=10

162 (!!!!! 7934.8087310791): select jos_linkedin.link from jos_linkedin where cat=10

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