Date Published: April 4, 2017
Publisher: Public Library of Science
Author(s): Wei Zhang, Liyan Ma, Brent A. Bauer, Zhishun Liu, Yao Lu, Praveen Thumbikat.
This systematic review and meta-analysis aims to assess the therapeutic and adverse effects of acupuncture for benign prostatic hyperplasia (BPH) in randomized controlled trials (RCTs).
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, the Chinese Biomedical Database, the China National Knowledge Infrastructure, the VIP Database and the Wanfang Database. Parallel-group RCTs of acupuncture for men with symptomatic BPH were included. Data from the included trials were extracted by two independent reviewers and were analyzed with The Cochrane Collaboration Review Manager software (RevMan 5.3.5) after risk of bias judgments. The primary outcome measure of this review was a change in urological symptoms.
Eight RCTs, which involved 661 men with BPH, were included. Follow-up varied from 4 weeks to 18 months. Pooling of the data from three trials that compared acupuncture with sham-acupuncture revealed that in the short term (4–6 weeks), acupuncture can significantly improve IPSS (MD -1.90, 95% CI -3.58 to -0.21). A sensitivity analysis of the short-term endpoint showed the same result (MD -3.01, 95% CI -5.19 to -0.84) with a borderline minimal clinical important difference (MCID). Qmax of the short-term endpoint indicated statistically positive beneficial effects of acupuncture (MD -1.78, 95%CI -3.43, -0.14). A meta-analysis after medium-term follow-up (12–18 weeks) indicated no significant effect on IPSS when the data from two trials were combined (MD -2.04, 95% CI -4.19, 0.10).
Statistically significant changes were observed in favor of acupuncture in moderate to severe BPH with respect to short-term follow-up endpoints. The clinical significance of these changes needs to be tested by further studies with rigorous designs and longer follow-up times.
Benign prostatic hyperplasia (BPH) is the most commonly encountered urologic disease among older men. Studies have reported the prevalence of BPH to be approximately one-quarter of men in their 50s, one-third in their 60s, and about half in their 80s [1, 2]. Interventions for BPH include minimally invasive therapies, surgical therapies and medical therapies (including those derived from plants, which is known as phytotherapy) [3, 4]. Acupuncture is a therapy characterized by the stimulation of certain anatomical points (acupoints) using diverse techniques, such as penetration of the skin, with different types of needles. With a literary history of more than 2000 years , acupuncture has always been a routine practice in China. In addition, traditional Chinese medicine (TCM) books have revealed the way in which acupuncture can be used to treat diseases . Currently, to some extent, acupuncture has become a popular practice worldwide. Both a WHO report and a National Institutes of Health consensus conference have provided lists of diseases that could be potentially managed with acupuncture [7, 8].
The protocol used in this systematic review and meta-analysis was published previously with the registration number PROSPERO CRD42014013645 (see S1 Protocol) . A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist is available as supporting information; see S1 Checklist.
Eight trials involving 661 men with BPH were included in this review. As a traditional Chinese therapy, acupuncture is dependent on the experience of the acupuncturist so that the correct location of the acupoints and the correct manipulations are guaranteed. All included trials claimed adequate qualification of acupuncture providers. We did not penalize trials for their high risk of performance bias with respect to the blinding of participants, as it is not possible to blind all acupuncturists and patients who participate in trials with a control group other than sham acupuncture by certain methods. However, some trials did successfully blind patients by selecting acupoints located on the body outside of the participants’ field of vision.
Statistically significant changes were observed in short-term follow-up endpoints in favor of acupuncture in moderate to severe BPH. However, it is not certain whether clinically significant outcomes can be achieved by acupuncture. We recommend future studies to assess sham/placebo acupuncture with reasonable methods, such as control intervention, to determine acupoints or needle type specificity for BPH. Whenever possible, a multi-centered study involving patients of more races and regions should be performed. An acupuncture study with active comparators of medication should be implemented synchronously using good inclusion criteria and strict informed consent.