Reference: Ann Intern Med. 2021 Aug 17
Chronic nonbacterial prostatitis/chronic pelvic pain syndrome affects between 2-10% of men and is associated with high rates of depression, erectile dysfunction, and a decline in quality of life. Treatment options range from antibiotics to spermatic cord denervation and perineal shock wave therapy. There is inconsistent and limited evidence for a single therapy, as many patients experience benefit with placebo in randomized trials. Guidelines recommend a multimodal approach focused on symptom reduction. In previously published small, short randomized trials, acupuncture improved prostatitis symptoms as compared to sham.
Investigators at multiple centers in China conducted a randomized trial to examine the efficacy of acupuncture versus sham. A total of 440 participants were randomized to traditional acupuncture (n=220) with gentle manipulation at a depth of 25-60 mm or sham (n=220) with similar needles inserted at nonacupoints to a depth of 2-3 mm without manipulation. The investigators blinded participants by placing these similarly located needles while prone. Over an 8-week period, participants received 20 sessions of the assigned treatment and were then followed for 24 weeks after treatment. The primary outcome was the proportion of responders at both 8 and 32 weeks, defined by a 6-point improvement in the National Institute of Health Chronic Prostatitis Symptom Index (NIH-CPSI, range 0-43 points, with higher scores being worse). At baseline, participants had an average age of 35 with 2 years of symptoms and a mean NIH-CPSI score of 31 points in both groups.In the acupuncture group, the response rate was 60.6% at 8 weeks and 61.5% at 32 weeks. The sham group response rate was 36.8% and 38.3% at 8 and 32 weeks respectively, for an adjusted odds ratio of 2.6, 95% CI 1.7-3.9, NNT=5. Improvement in total NIH-CPSI score was greater in the acupuncture group as compared to sham (-7.4 points vs. -4.9 points, adjusted difference -2.6 points, 95% CI -3.5 to -1.6 points). The acupuncture group had greater improvement in other measures of prostatitis, urinary, and anxiety symptoms. There were no significant differences in urinary flow measurements, erectile function, or in use of other treatments between acupuncture and sham groups. Rates of adverse events were low but subcutaneous hematomas were more common in the acupuncture group as compared to sham (9 vs. 5, respectively).
These data represent the largest trial with longest follow-up to date evaluating acupuncture versus sham for chronic prostatitis. Although the acupuncture group achieved the 6-point threshold for clinically meaningful improvement, there was only a 2-point adjusted difference between the acupuncture and sham groups at 32 weeks, suggesting a small magnitude of effect. Additionally, feasibility, availability, and general acceptance of acupuncture as an effective treatment option outside of China may limit uptake across the rest of the world. Regardless, with an NNT of 5 and potential for sustained benefit without significant adverse effects, acupuncture has the potential to become a standard treatment option for chronic prostatitis.
For more information, see the topic Chronic Prostatitis/Chronic Pelvic Pain syndrome in DynaMed.
DynaMed EBM Focus Editorial Team
This EBM Focus was written by Carina Brown, MD, Assistant Professor at Cone Health Family Medicine Residency. Edited by, Alan Ehrlich, MD, Executive Editor at DynaMed and Associate Professor in Family Medicine at the University of Massachusetts Medical School; Dan Randall, MD, Deputy Editor at DynaMed; Katharine DeGeorge, MD, MS, Associate Professor of Family Medicine at the University of Virginia and Clinical Editor at DynaMed; Nicole Jensen, MD, family physician at WholeHealth Medical; Tanya Tupper, RT(N), CNMT, PET, Senior Medical Writer at DynaMed, Vincent Lemaitre, PhD, Medical Writer at DynaMed and Christine Fessenden, Editorial Operations Assistant at DynaMed.