Professor Gou Xin, a famous guide in the guide: Thoroughly understand the guide - qualified doctors know it, and excellent doctors know it

"Safety for "Medicine" is a humanities case collection project in cooperation between Beijing Chen Jumei 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 .

In the field of oncology, with the continuous development of new drugs and the development of prospective randomized clinical trials, the clinical guidelines have maintained Faster update frequency, but the complex and highly heterogeneous disease course and prognosis of patients in the clinic still bring continuous challenges and difficulties to diagnosis and treatment
.

In order to ensure the full benefit of patients, reduce unnecessary burden of diagnosis and treatment, and promote tumor Standardization of diagnosis and treatment is imperative
.

In this issue, we invited Professor Gou Xin from the First Affiliated Hospital of Chongqing Medical University to talk about the relationship between clinical guidelines and standardized diagnosis and treatment of prostate cancer, and the value of standardized diagnosis and treatment to clinical and patients.
And his reflections and advice on the clinician's study guide
.

Expert Profile Professor Gou Xin Chief Physician Doctoral Supervisor Director of Urology Department of the First Affiliated Hospital of Chongqing Medical University Director of Urology Specialized Committee of Chinese Medical Association Member of the Standing Committee of Urology Specialized Committee of Chinese Medical Association Secretary General of Oncology Group of Chinese Medical Association Urology Specialized Committee Member of Urology Branch of Chinese Medical Doctor Association China Standing member of the Prostate Cancer Expert Committee of the Society of Clinical Oncology Chairman of the Urology and Male Genital Oncology Committee of the Chongqing Anti-Cancer Association Former Chairman of the Urology Specialized Committee of the Chongqing Medical Association "Gospel", also a clinical "armor", Professor Gou Xin mentioned that there is only castration treatment for advanced prostate cancer in the early years, and doctors have very limited choices, and naturally there will not be too many differences; and in recent years, with enzalutamide With the introduction of new endocrine drugs such as abiraterone and abiraterone into the clinic, and the emergence of precision medical measures such as genetic testing, different combinations and sequences of diagnosis and treatment decisions may greatly affect the prognosis of patients, which also makes the standardized treatment of prostate cancer more important.

.

For patients, the promotion of standardization will help clinicians at all levels and hospitals to provide them with medical solutions that are recognized in the field and maximize potential benefits under the guidance of unified clinical guidelines and rigorous medical evidence-based , optimize the process of diagnosis and treatment, reduce direct and indirect treatment costs, bring deeper benefits and improve the quality of life
.

For doctors, the guideline recommendations and standardization allow doctors to have evidence for every clinical treatment choice, which not only makes up for the limitations of personal experience, but also assists doctor-patient communication, and even helps doctors when possible.
Provides "protection" in disputes
.

At the same time, Professor Gou Xin also pointed out that standardized treatment and individualized treatment are not contradictory, but complement each other
.

For advanced prostate cancer patients with more comorbidities, under the framework of standardized diagnosis and treatment, it is necessary to make corresponding and more refined choices based on the individual characteristics of patients
.

For example, enzalutamide and abiraterone are new endocrine therapy drugs, but for patients with cardiovascular disease, diabetes or other metabolic diseases, it is necessary to consider avoiding the combination of glucocorticoids
.

In addition, individualized treatment is also reflected in assessment-based diagnosis and treatment.
Clinicians should select and change treatment methods according to the individual patient's response to drugs and adverse reactions, disease changes and development
.

"We can't stick to the end, we can't use one medicine to the end, and we have to make choices in time if there are changes.
I think individualized diagnosis and treatment is also reflected in this aspect
.

" The original research behind the study guide: know it and know it The reason why clinical guidelines are based on the evidence generated by systematic reviews and the evaluation of the pros and cons of various alternative intervention methods is to assist evidence-based clinical decision-making to achieve optimal benefits
.

Professor Gou Xin believes that clinical guidelines can inform clinicians about the principles of prostate cancer treatment in a concise and to-the-point way, helping doctors to understand how to decide on a patient's clinical treatment plan
.

However, he also pointed out that doctors can't just treat all patients according to the guidelines, but also need to learn what is behind the guidelines - that is, to extract the research and literature behind the principles of these guidelines, analyze the characteristics of the patients included in the research, and understand the reasons for the conclusions drawn from the research.
process and explore the applicability of different research conclusions
.

These in-depth explorations can enable clinicians to better practice the guidelines and bring more benefits to patients
.

In the promotion of guidelines and standardized diagnosis and treatment, Professor Gou Xin also emphasized the need to increase internal learning and external education
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He pointed out that some clinicians still have insufficient grasp or attention to the guidelines.
For example, for patients who have entered the castration-resistant stage, bicalutamide can no longer benefit patients, but some physicians continue to use it.
This is the norm.
treatment prohibited
.

Professor Gou Xin pointed out that this is because the current clinicians do not have a deep understanding of the guidelines, they have not explored the meaning behind each principle, and they do not understand the mechanism of "resistance" in patients with castration-resistant prostate cancer - which requires More clinical guides will be preached, so that every practitioner of prostate cancer can have an in-depth understanding of the guidelines, not only how to treat them, but also why they should be treated in this way
.

The 2021 Chinese Society of Clinical Oncology (CSCO) guidelines for prostate cancer diagnosis and treatment re-emphasize that the diagnosis and treatment of prostate cancer should pay attention to the development of multidisciplinary diagnosis and treatment (MDT), and recommends qualified units as much as possible Carry out MDT in many places to provide patients with full-process medical decision-making and health management solutions
.

Professor Gou Xin pointed out that although the MDT that can be implemented in China is mainly concentrated in teaching hospitals and high-level hospitals, the role of MDT in promoting clinical diagnosis and treatment is obvious to all
.

On the one hand, Professor Gou Xin mentioned that MDT can optimize medical plans, integrate the views of physicians in different departments, and help patients get higher benefits
.

"A ruler is short, an inch is long - each doctor's knowledge structure is different, and they have their own areas of expertise and their own shortcomings.
For example, urologists may not be familiar with the use of radiotherapy and the principles of genetic testing.
Through the MDT mode
of
treatment, doctors from various disciplines can brainstorm and combine the strengths of all doctors to formulate the most suitable treatment plan for patients
.

” On the other hand, Professor Gou Xin believes that what is more important is that MDT plays a role in the doctor’s self- discipline.
role in learning and improvement
.

"All departments get together, and if you want to really collide with opinions and realize MDT, you must read books, read literature, and master new knowledge, and you can't say a few words repeatedly
.

This can also promote our clinical practitioners to deepen their knowledge of all aspects of prostate cancer, whether it is basic, pharmacological knowledge, or knowledge of all aspects of treatment such as surgical treatment and radiotherapy
.

In the end, Professor Gou Xin concluded: "In the study and practice of the guide, we also need to learn the things behind the guide, from vague knowledge, the state of knowing but not knowing why, to gradually understanding why the guide recommends this way.
, why something new - so you can be a good urologist
.

"Special thanks to: Beijing Astellas Pharmaceutical Co.
, Ltd.