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Psutka SP, Veleber S, Siman J, Holt SK, Jannat S, Wright JL, Lin DW, Gore JL, Schade GR, Annen Z, Greenlee H. Phase 1/2 Randomized Clinical Trial of In-clinic acupuncture Prior to Bacillus Calmette-Guérin in Patients with High-risk Non-muscle-invasive Bladder Cancer. Eur Urol Oncol 2024:S2588-9311(24)00091-9. [PMID: 38653622 DOI: 10.1016/j.euo.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 03/01/2024] [Accepted: 04/08/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Treatment-related dose-limiting dysuria and irritative bladder symptoms are common in patients receiving intravesical bacillus Calmette-Guérin (BCG) to treat non-muscle-invasive bladder cancer (NMIBC). Acupuncture has been shown to reduce pain and urinary urgency/frequency in other patient populations. OBJECTIVE To evaluate the feasibility, safety, and tolerability of weekly in-clinic preprocedural acupuncture among patients receiving induction BCG. DESIGN, SETTING, AND PARTICIPANTS Patients with high-risk NMIBC undergoing induction BCG were randomized 2:1 to a standardized acupuncture protocol (acupuncture) versus the standard-of-care control arm. INTERVENTION In-office acupuncture prior to each BCG instillation. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSES Feasibility was assessed via recruitment, retention, and intervention adherence. Acupuncture safety and tolerability were assessed via physician-reported Common Terminology Criteria for Adverse Events version 5.0 and adverse events (AEs). Secondary endpoints included BCG treatment adherence, patient-reported BCG-related toxicity, and bladder cancer-specific and generic (European Organisation for Research and Treatment of Cancer [EORTC]-QLQ-NMIBC-24 and EORTC-QLQ-NMIBC-C30) quality of life (QOL). Subjective assessments of acupuncture acceptability were performed through patient surveys. RESULTS AND LIMITATIONS A total of 43 individuals were randomized 2:1 to the acupuncture (n = 28) versus control (n = 15) group. The median age was 70.3 yr, and 76% were male. Week 7 follow-up surveys were completed by 93%; six participants withdrew early due to disease progression, refractory gross hematuria, or preference. Acupuncture was delivered successfully prior to each BCG treatment, with no acupuncture-related AEs or interruptions to induction BCG. BCG-attributed AEs were reported by 91% acupuncture and 100% control individuals, including pain (28% vs 43%, p = 0.34) and urinary symptoms (62% vs 79%, p = 0.31). Comparing acupuncture patients with controls, change in QOL over the study period demonstrated greater improvements in median urinary symptoms (9.5, interquartile range [IQR] 0.0-19.0 vs 0.0, IQR -14.3 to 7.1; p = 0.02) among patients in the acupuncture arm. Of the acupuncture patients, 96% reported that acupuncture was "very/extremely helpful," and 91% would recommend acupuncture to other patients. Limitations include modest sample size and single-institution design. CONCLUSIONS Acupuncture prior to induction BCG treatments is feasible and safe. In this phase 1/2 trial, improved urinary function scores were observed among patients undergoing acupuncture. Patients receiving acupuncture reported high degrees of satisfaction with treatments. PATIENT SUMMARY We evaluated the safety and feasibility of delivering acupuncture in a urology clinic prior to weekly intravesical bladder cancer treatments with bacillus Calmette-Guérin (BCG) in a randomized controlled trial. We found that acupuncture could be delivered safely prior to weekly BCG instillations and that the use of acupuncture was associated with high patient satisfaction and a decrease in patient-reported urinary symptoms compared with usual care.
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Affiliation(s)
- Sarah P Psutka
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Susan Veleber
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jonathan Siman
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarah K Holt
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Samia Jannat
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Jonathan L Wright
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Daniel W Lin
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - John L Gore
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - George R Schade
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Zachary Annen
- Department of Urology, University of Washington School of Medicine, Seattle, WA, USA
| | - Heather Greenlee
- Integrative Medicine Program, Division of Supportive Care, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA; Division of Medical Oncology, Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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Wang H, Lei X, Ma D, Zhao Z, Wang A, Du G, Zhang J, Wang F, Guo J. Efficacy of acupuncture for psychogenic erectile dysfunction: a randomized, sham-controlled trial. Basic Clin Androl 2023; 33:40. [PMID: 38124064 PMCID: PMC10734192 DOI: 10.1186/s12610-023-00215-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Psychogenic erectile dysfunction (pED) is a common sexual dysfunction often accompanied by psychosomatic factors. Its treatment includes oral medications, psychotherapy, and behavioral therapy. Acupuncture's effect on erectile function in pED patients remains to be investigated. This randomized study evaluated the effects of acupuncture and sham acupuncture in pED patients. Altogether, 66 men with pED were randomized to the acupuncture (n = 33) or sham acupuncture group (n = 33). Both groups have a 6-week treatment with 18 sessions. Primary outcome was the International Index of Erectile Function-5 (IIEF-5) at 6 weeks. Secondary outcomes were IIEF-5 (weeks 2, 4, and 10), erection hardness score (EHS), sexual encounter profile-2 (SEP-2), SEP-3, self-rating anxiety scale (SAS), and self-rating depression scale (SDS). RESULTS Among the 66 participants, 64 completed the outcome measurements at week 10. Both acupuncture and sham acupuncture groups had improved IIEF-5 and EHS and decreased SAS and SDS post-treatment (p < 0.05). The acupuncture group had significantly better improvement in IIEF-5, EHS, and SEP-3 and significantly reduced SAS and SDS than the sham acupuncture group (p < 0.05). The improvement in SEP-2 post-treatment was not significantly different between the two groups (p > 0.05). There were no serious adverse events. CONCLUSIONS The 6-week acupuncture treatment significantly improved the erectile capacity and psychosomatic status of pED patients. TRIAL REGISTRATION ChiCTR2200064345 (Chinese Clinical Trial Registry) ( https://www.chictr.org.cn/showproj.html?proj=174873 ).
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Affiliation(s)
- Hao Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Xulu Lei
- Department of Preventive Care Center, Beijing Fengtai Hospital of Integrated Chinese and Western Medicine, Beijing, China
| | - Dongyue Ma
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Ziwei Zhao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Anmin Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanchao Du
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiwei Zhang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Fu Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, China.
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Wang H, Zhang J, Ma D, Zhao Z. The Role of Acupuncture and Its Related Mechanism in Treating Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Int J Gen Med 2023; 16:4039-4050. [PMID: 37700742 PMCID: PMC10493142 DOI: 10.2147/ijgm.s417066] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023] Open
Abstract
Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the most common diseases in urology, and its prevalence has been increasing, causing serious urogenital problems in men. Several targeted oral drug therapies exist to treat the pelvic pain experienced in this disease. However, these therapies may have potential adverse effects, and due to the unique location of the prostate, delivery of medications to the target lesion is difficult. Consequently, many patients seek alternative therapies. Acupuncture is a well-established treatment method in traditional Chinese medicine that can improve CP/CPPS symptoms and reduce pain. However, previous systematic reviews overlooked the significance of the characteristics and mechanisms of acupuncture therapy. This study aimed to summarize the characteristics and benefits of acupuncture therapy for CP/CPPS based on relevant literature and predict and analyze its related mechanisms.
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Affiliation(s)
- Hao Wang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Jiwei Zhang
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Dongyue Ma
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
| | - Ziwei Zhao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Beijing, People’s Republic of China
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