Beer, T. M., Benavides, M., Emmons, S. L., Hayes, M., Liu, G., Garzotto, M., . . . Eilers, K. (2010). Acupuncture for hot flashes in patients with prostate cancer. Urology, 76, 1182–1188.

 To determine the effect of acupuncture on hot flash (HF) frequency and intensity, quality of life, and sleep quality in patients undergoing hormonal therapy for prostate cancer.

Men with HF scores greater than four who received androgen-depriving therapy underwent acupuncture with electrostimulation biweekly for four weeks then weekly for six weeks using a predefined treatment plan. Patients completed a Hot Flash Diary daily for seven days prior to treatment then daily throughout the study.

• The sample was comprised of 22 males with prostate cancer.  
• Median age was 71 years.
• Patients were undergoing androgen deprivation therapy.

The study enrolled men with prostate cancer who were treated with bilateral orchiectomy, gonadotropin-releasing hormone agonist, or antagonists with or without antiandrogen therapy. The sample group reported at least four HFs per day. They could not be receiving concurrent chemotherapy, estrogens, progesteronal agents, or gabepentin. They had to be off of selective serotonin reuptake inhibitor (SSRI) class antidepressants for at least two weeks; however, the SSRI prohibition was removed after 16 patients were enrolled to speed accrual. Patients with pacemakers or other electrical devices were excluded.

• Single site   
• Outpatient   
• Sweden

• Patients were undergoing the active treatment phase of care.
• The study has clinical applicability for late effects and survivorship and elderly care.

The study used an open-label, single arm, phase II design.

• Hot Flash Related Daily Interference Scale (HFDIS)
• Pittsburgh Sleep Quality Index (PSQI)
• Short Form 36-item Health Survey (SF-36)
• Blood samples plasma calcitonin gene-related peptide (CGRP)
• Urine samples 5-HIAA
• Hot Flash Diary

Acupuncture treatment was administered twice weekly, with an attempt to use the same practitioner throughout the treatment period. Specific acupuncture sites were used in all patients. The HF score was calculated from the Hot Flash Diary, and each HF was calculated to determine severity. The severity-adjusted HF scores were summed for seven days. Biomarkers were assessed at baseline; 2, 4, 6, and 10 weeks of treatment; and again after 6 weeks. The mean HF score was reduced after four weeks of therapy, then reduced to 52% of baseline at eight weeks. The HFDISs were available for 21 of the improved patients. The PSQI was available for 19 patients, but there was no statistical significance noted from baseline to after 10 weeks of treatment. No improvement in overall vitality was measured by the SF-36. No significant adverse effects were noted. Regarding the biomarkers, no change in the serum serotonin levels was noted for any patient. Urinary 5-HIAA had a nonsignificant trend toward reduced 5-HIAA concentrations, with the nonresponders (two patients) having an increase over time. The nonresponders' 5-HIAA concentrations were 129% of baseline, whereas the responders at week 10 showed 73.3% of baseline concentrations. The CGRP levels baseline sample results were so diverse that subsequent samples obtained during and posttreatment detected no meaningful differences. The variability in the CGRP samples reduced the statistical power of the study to detect differences.

The study suggested that acupuncture may be an active nonpharmacologic option for patients with prostate cancer experiencing HFs while undergoing hormonal treatment.

• The study had a small sample size, with less than 30 patients.
• Hot flash Diaries were incomplete beyond week 8, so the severity of hot flashes was not calculable past the time point proposed.
• The variability in the CGRP samples reduced the statistical power of the study to detect differences.

Further research is needed in the use of acupuncture in reducing HF scores and improving sleep quality in prostate cancer survivors. Further research may also be needed  to determine if differences exist between genders for HF distress/occurrence and sleep quality, which may provide some direction for extrapolating research results with either gender group.