Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A GRADE-assessed Systematic Review and Meta-analysis

CONTEXT: Acupuncture is a promising therapy for relieving symptoms in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), which affects 9–16% of adult men worldwide. OBJECTIVE: This study aims to explore the efficacy and safety of acupuncture for CP/CPPS. EVIDENCE ACQUISITION: Nine electronic databases were searched. Only randomized controlled trials were included. Two reviewers extracted data and assessed the risk of bias of trials using the revised Cochrane risk-of-bias (RoB 2.0) tool. Stata 17.0 was used to analyze the data. EVIDENCE SYNTHESIS: Twelve trials were included. The results of a meta-analysis showed that acupuncture had larger effect sizes (standardized mean difference [SMD] = –1.20, confidence interval or CI [–1.69, –0.71], acupuncture compared with sham acupuncture; SMD = –1.01, CI [–1.63, –0.38], acupuncture compared with medication; SMD = –0.91, CI [–1.29, –0.54], acupuncture plus medication compared with medication) in reducing the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total score. In decreasing NIH-CPSI pain domain score, acupuncture also led to larger effect sizes (SMD = –0.94, CI [–1.18, –0.70], acupuncture compared with sham acupuncture; SMD = –1.04, CI [–1.29, –0.79], acupuncture compared with medication; SMD = –0.85, CI [–1.23, –0.48], acupuncture plus medication compared with medication), whereas the effect sizes in the reduction of NIH-CPSI urinary domain and quality of life domain scores were medium. Compared with sham acupuncture and medication, acupuncture appears to be more effective in improving the global response rate. Results from four trials indicated that acupuncture was better than sham acupuncture in decreasing the International Prostate Symptom Score. No serious adverse effects were found in the acupuncture treatment. CONCLUSIONS: Current evidence supports acupuncture as an effective treatment for CP/CPPS-induced symptoms, particularly in relieving pain. Comprehensive acupuncture treatment according to individual symptoms should be considered in future clinical practice and trials for CP/CPPS. PATIENT SUMMARY: In this study, we further verified the efficacy of acupuncture in patients with chronic prostatitis/chronic pelvic pain syndrome, especially in reducing pain.