Professor Zhang Shilong took the "Guide" and opened up the road of clinical exploration

"Safety with Medicine" is a humanistic case collection project cooperating with Beijing Chen Jumei Public Welfare Foundation and Yimaitong
.
The
series of interviews with physicians in urology will focus on the field of prostate cancer, and discuss the path of standardized diagnosis and treatment of prostate cancer based on real clinical needs.
and the importance of whole course management to clinical patients, highlighting the research spirit and professional quality of urological oncologists
.
The
clinical guidelines are proposed by the expert team in the field based on the existing evidence and the advantages and disadvantages of various alternative intervention methods.
Guidance is authoritative and instructive, and the design of high-level evidence-based research included in the guideline is relatively strict, and researchers will conduct special screening according to the clinical manifestations, intervention measures and intervention time of patients participating in the trial
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However, in real diagnosis and treatment scenarios, urinary tract The conditions of prostate cancer patients faced by surgeons are often more complex, which requires doctors to carry out individualized treatment according to the actual situation, and also requires doctors to continuously verify and explore the guidelines according to practice
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This interview is invited to Henan Province .
Professor Zhang Shilong, deputy director of the Department of Urology and Andrology, People's Hospital, came to talk to us about his views on guideline recommendation and empirical diagnosis and treatment in the actual diagnosis and treatment situation, as well as his thoughts and choices in practice
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Expert introduction Professor Zhang Shilong, MD, Chief Physician, Master Physician Student Tutor Deputy Director of Urology and Andrology Department of Henan Provincial People's Hospital Vice President of Andrology Branch of Henan Provincial Medical Association Member and Secretary General of Andrology Branch of Henan Medical Association Member of Male External Genital Plastic Surgery and Rehabilitation Committee of Chinese Medical Doctor Association Secretary of Prostate Group of Andrology Branch of Chinese Medical Association Henan Deputy Head of the Prostate Group of the Andrology Branch of the Provincial Medical Association Member of the Standing Committee of the Surgery Branch of the Chinese Society of Sexuality, Member of the Standing Committee of the Prostate Disease Branch of the Chinese Society of Sexuality There is also a need for “prescribed medicines” clinical guidelines that are optimal guidance based on evidence generated from systematic reviews and an evaluation of the benefits and harms of various alternative interventions
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The formulation of the guideline will help the principles of evidence-based medicine to be better implemented and implemented in clinical medical practice, and it is also of great significance to standardize the medical behavior of doctors and improve the quality of medical services
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Clinical guidelines can provide diagnosis and treatment recommendations for specific groups of people, with features such as applicability and flexibility, but even for the same clinical problem, different countries and even different regions of the same country have different treatment decisions
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"Clinical guidelines are only a normative reference, but for each patient, it must be analyzed on a case-by-case basis
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If patients have differences in past medical history, imaging evaluation of bone metastases, and comorbidities, treatment decisions and benefits may also be Taking prostate cancer patients as an example
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Professor Zhang Shilong pointed out that if the patients’ baseline prostate-specific antigen (PSA) level, Gleason score and cancer cell metastasis level are different, then the treatment decision will also be different
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"I think there should be different treatments for different patients, because prostate cancer is a very heterogeneous tumor.
We should not only stratify, but also differentiate treatment for individuals on the basis of stratification
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" Professor Zhang Shilong also mentioned that when a patient has severe cardiovascular symptoms, if a long-term combined hormone therapy is still performed, the probability of adverse cardiovascular events in the patient will increase
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This also prompts doctors to make optimal treatment decisions suitable for patients according to the characteristics of patients under the treatment principles of guidelines
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When asked whether clinical guidelines are the "gold standard" for practice, Professor Zhang Shilong pointed out: "The normative nature of guidelines is relative, and there must be areas beyond the guidelines that require medical workers to continuously explore and innovate.
If we all refer to the guidelines invariably, how can we update the guidelines?” In actual clinical work, there are differences between the testing plan, follow-up assessment, treatment application timing, prescription order, drug combination, etc.
of special populations and ordinary patients.
, with the expansion of indications and combined use of drugs over time, these parts beyond the guidelines require doctors to adjust diagnosis and treatment strategies according to specific situations
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Likewise, actual "benefits" from clinical practice will guide further exploration of research and update of guidelines
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"For example, in the early years enzalutamide was used to treat metastatic castration-resistant prostate cancer (mCRPC) after chemotherapy, but at that time some prostate cancer patients rapidly entered the mCRPC stage after two months of abiraterone treatment.
In the absence of chemotherapy, we tried to use enzalutamide for treatment at that time, and the PSA quickly decreased, and a better clinical effect was obtained
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"At present, with the accumulation of evidence, enzalutamide has been approved for use before chemotherapy.
mCRPC and non-metastatic castration-resistant prostate cancer (nmCRPC) patients at high risk of metastasis
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Professor Zhang Shilong pointed out that in the case of determining diagnosis and treatment decisions, it is sometimes necessary to appropriately expand or carry out exploratory use.
"Treatment for the purpose of benefiting patients is feasible and exploratory
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" Different types of research are mutually beneficial.
Supplementary, providing new ideas for guideline formulation.
Clinical trials are an indispensable and important link in the development and application of new drugs, and are also an important supplement to clinical anti-tumor therapy.
In certain circumstances, clinical trials may bring better benefits to patients
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Professor Zhang Shilong believes that when a drug enters the clinical trial stage, it means that it has already had sufficient preliminary research, and at this time, both the safety and effectiveness of the drug have a certain guarantee
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Professor Zhang Shilong also mentioned that if there is currently no feasible treatment plan for patients, clinical trial drugs can be selected as emergency applications
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For example, after the outbreak of new coronary pneumonia, many drugs that have not been approved by the U.
S.
Food and Drug Administration (FDA) have been put into clinical use as emergency drugs, but this emergency application should also be based on safety and effectiveness
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Professor Zhang Shilong also recommends prostate cancer patients to participate in clinical trials when the current approved drugs cannot control disease progression well
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"Evidence-based medicine has limitations, and there are still some differences between some of our clinical trials and real-world research data
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" Evidence-based medicine evidence or guideline recommendations based only on clinical trial results may lack sufficient extrapolation , making it difficult to translate into clinical practice
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Based on high-quality evidence from clinical trials or systematic reviews, a comprehensive body of evidence supplemented by real-world research data may provide new ideas for the formulation of clinical practice guidelines.
Real-world research is also becoming the focus of attention in the medical and health field
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Professor Zhang Shilong pointed out that real-world research is mostly retrospective analysis or post-hoc analysis, which is not only convenient to carry out, but also more in line with clinical practice
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Therefore, when referring to real-world research data, clinical practice should look at it with a dialectical perspective, think with dialectical thinking, remove the false and preserve the true, and choose its reasonable components
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Adhering to the combination of theory with practice and adherence to the essential clinical guidelines of medicine is a way to standardize doctors' medical behavior and avoid huge deviations between doctors' diagnosis and treatment decisions and the actual situation as much as possible
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Professor Zhang Shilong believes that from the perspective of clinical development, leading experts in the field and senior clinical doctors can actively explore, make breakthroughs and innovations on the basis of guidelines, and form new views and even new consensus; In other words, in the initial stage, it is still necessary to think within the scope stipulated in the guidelines and lay a solid foundation
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In addition, Professor Zhang Shilong also pointed out that medicine is neither a purely theoretical nor a purely practical discipline.
Young doctors should follow the track of combining theory with practice from the very beginning, and only combine their own understanding in practice.
In order to develop new theories, we can further improve our medical literacy and serve the public better
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Regarding his nearly 30 years of medical experience, Professor Zhang Shilong believes that the initial essence of medicine is love and care, so young doctors must have a benevolent love from the very beginning.
Only in this way can they listen to the voices of patients and understand their Needs, find problems in clinical practice, analyze problems, help patients solve problems, grow in solving problems, and gradually improve their medical literacy
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Summary Clinical guidelines are a summary of the best medical practices for specific clinical problems, which are of great significance for guiding clinical treatment.
However, Professor Zhang Shilong pointed out that the guidelines only provide a framework of recommendations and cannot be all-encompassing.
For patients whose clinical conditions are beyond the guidelines It is also necessary for doctors to implement a diagnosis and treatment plan beyond the guidelines according to their own experience, with the fundamental principle of improving the benefit of patients
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With the continuous deepening of medical practice, clinical guidelines are also constantly updated.
As a doctor, we should adapt to the update, and we must also have the courage to explore while constantly learning, so as to continue to improve
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Review of Past Issues 1.
Dr.
Cai Yi | Walking against "swelling": Looking back on the past and making a voice in the field of prostate cancer 2.
Prof.
Tang Qi | "Diagnosis" insights: Talking about prostate cancer under the new diagnostic technology Development of the concept of diagnosis and treatment 3.
Prof.
Cui Feilun | "Talking about" the male commentary: Talking about the clinical diagnosis and treatment of prostate cancer "intrigue" with androgens Excellent doctors know why | Persistently seeking for the right to be a benevolent technique, and cherishing the patient Fang Cheng’s heart : Development and Prospect of Prostate Cancer Treatment under MDT Mode