Complementary therapies in the control of male lower urinary tract symptoms: A systematic review

Mata, Luciana Regina Ferreira da; Motter, Paula Giuliana Rodrigues; Azevedo, Cissa; Bernardes, Mariana Ferreira Vaz Gontijo; Chianca, Tânia Couto Machado; Vasques, Christiane Inocêncio

doi:10.1590/1518-8345.5897.3597

person Luciana Regina Ferreira da Mata

school Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.

0000-0002-5080-4643

person Paula Giuliana Rodrigues Motter

school Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.

0000-0002-7881-0519

person Cissa Azevedo

school Universidade Federal de Viçosa, Departamento de Medicina e Enfermagem, Viçosa, MG, Brazil.

0000-0001-5881-5710

person Mariana Ferreira Vaz Gontijo Bernardes

school Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.

0000-0002-5051-4910

person Tânia Couto Machado Chianca

school Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil.

0000-0002-8313-2791

person Christiane Inocêncio Vasques

school Universidade de Brasília, Faculdade de Ciências da Saúde, Brasília, DF, Brazil.

0000-0001-9586-9486

personCorresponding author Christiane Inocêncio Vasques E-mail:
chvasques@unb.br

Associate Editor

Maria Lúcia Zanetti

groupsAuthors’ contribution

Study concept and design: Luciana Regina Ferreira da Mata, Paula Giuliana Rodrigues Motter, Christiane Inocêncio Vasques. Obtaining data: Luciana Regina Ferreira da Mata, Paula Giuliana Rodrigues Motter, Cissa Azevedo, Mariana Ferreira Vaz Gontijo Bernardes, Tânia Couto Machado Chianca, Christiane Inocêncio Vasques. Data analysis and interpretation: Luciana Regina Ferreira da Mata, Paula Giuliana Rodrigues Motter, Cissa Azevedo, Mariana Ferreira Vaz Gontijo Bernardes, Tânia Couto Machado Chianca, Christiane Inocêncio Vasques. Obtaining financing: Luciana Regina Ferreira da Mata, Tânia Couto Machado Chianca. Drafting the manuscript: Luciana Regina Ferreira da Mata, Paula Giuliana Rodrigues Motter, Cissa Azevedo, Mariana Ferreira Vaz Gontijo Bernardes. Critical review of the manuscript as to its relevant intellectual content: Luciana Regina Ferreira da Mata, Paula Giuliana Rodrigues Motter, Cissa Azevedo, Mariana Ferreira Vaz Gontijo Bernardes, Tânia Couto Machado Chianca, Christiane Inocêncio Vasques. All authors approved the final version of the text.

Conflict of interest

The authors have declared that there is no conflict of interest.

Databases	Search strategy
CINAHL	((“Complementary Therapies” OR “Alternative Medicine” OR “Alternative Therapies” OR “Complementary Medicine” OR “Complementary and Integrative Practices” OR “Medicine, Chinese Traditional” OR Acupressure OR Auriculotherapy OR “Acupuncture, Ear” OR “Acupuncture Therapy” OR “Ear, external” OR Electroacupuncture OR “Acupuncture Points” OR Moxibustion OR Reflexotherapy OR “Foot reflexology” OR “Zone Therapy” OR Meridians) AND (“Urinary Incontinence” OR “Urination Disorders” OR “Urinary Dysfunction” OR “Urinary Symptoms” OR “Urinary Incontinence, Stress”))
Embase	(‘lower urinary tract symptom’/exp OR ‘lower urinary tract symptom’) AND (‘chinese medicine’/exp OR ‘chinese medicine’)
LILACS	(tw:(((“Terapias Complementares” OR “Medicina Alternativa” OR “Medicina Complementar” OR “Terapias Alternativas” OR “Práticas Integrativas e Complementares” OR auriculoterapia OR “Acupuntura Auricular” OR “Terapia por Acupuntura” OR eletroacupuntura OR “Pontos de Acupuntura” OR moxibustão OR Medicina Tradicional Chinesa OR Meridianos OR Acupressão OR Orelha Externa OR “Complementary Therapies” OR “Alternative Medicine” OR “Alternative Therapies” OR “Complementary Medicine” OR “Complementary and Integrative Practices” OR auriculotherapy OR “Acupuncture, Ear” OR “Acupuncture Therapy” OR electroacupuncture OR “Acupuncture Points” OR moxibustion OR “Medicine, chinese traditional” OR Meridians OR Acupressure OR “Ear, external”)))) AND (tw:(((“Incontinência Urinária” OR “Transtornos Urinários” OR “Incontinência Urinária por Estresse” OR “Urinary Incontinence” OR “Urination Disorders” OR “Urinary incontinence, stress”))))
PEDro	Therapy: acupuncture; Problem: incontinence
PubMed	((“Complementary Therapies” OR “Alternative Medicine” OR “Alternative Therapies” OR “Complementary Medicine” OR “Complementary and Integrative Practices” OR “Medicine, Chinese Traditional” OR Acupressure OR Auriculotherapy OR “Acupuncture, Ear” OR “Acupuncture Therapy” OR “Ear, external” OR Electroacupuncture OR “Acupuncture Points” OR Moxibustion OR Reflexotherapy OR “Foot reflexology” OR “Zone Therapy” OR Meridians) AND (“Urinary Incontinence” OR “Urination Disorders” OR “Urinary Dysfunction” OR “Urinary Symptoms” OR “Urinary Incontinence, Stress”))
Web of Science	((“Complementary Therapies” OR “Alternative Medicine” OR “Alternative Therapies” OR “Complementary Medicine” OR “Complementary and Integrative Practices” OR “Medicine, Chinese Traditional” OR Acupressure OR Auriculotherapy OR “Acupuncture, Ear” OR “Acupuncture Therapy” OR “Ear, external” OR Electroacupuncture OR “Acupuncture Points” OR Moxibustion OR Reflexotherapy OR “Foot reflexology” OR “Zone Therapy” OR Meridians) AND (“Urinary Incontinence” OR “Urination Disorders” OR “Urinary Dysfunction” OR “Urinary Symptoms” OR “Urinary Incontinence, Stress”))
Google Scholar	Advanced search With all the words: Complementary Alternative Medicine With the exact phrase: Lower urinary tract symptomsWithout the words: Female; Children

Characteristics of the study			Description of the sample		Method applied			Outcomes analyzed		Final conclusions
Author(s) (Year); Country	CT^¶¶	Objectives	Size(n)	Characteristics (LUTS^‡‡‡ baseline; mean age ± standard deviation)	Intervention (IG^\|\|)	Control (CG^§)	Duration (months)	Assessment questionnaires	Urodynamics parameters
Gerber, et al. (2001)¹⁹; USA	PhT^‡	To evaluate the effects of Saw palmetto (S. palmetto) extract on urinary symptoms, sexual function, and urinary flow rate in men with LUTS^‡‡‡.	n: 85 IG^\|\|: 41 CG^§: 44	I-PSS^†† score > 8 without history of prostate surgery; 64.5 (±9.9) years old (IG^\|\|); 65.3 (±9.7) years old (CG^§).	160 mg S. palmetto capsule (distributed by Nutraceutical), 2x/day (320 mg a day).	Placebo capsule (extra virgin olive oil, gelatin and glycerin), 2x/day.	6	I-PSS^††	Qmax^\|\|\|\|	IG^\|\| had a mean reduction (improvement) of 4.4 (±5.9) points in the I-PSS score^††, showing a significant difference (p = 0.038) when compared to the CG^§. Qmax^\|\|\|\| improved slightly in both groups, but the changes were not significant (p = 0.75).
Bent, et al. (2006)²¹; USA	PhT^‡	To determine the efficacy of S. palmetto extract for the treatment of BPH^¶.	n: 225 IG^\|\|: 112 CG^§: 113	BPH determined by AUASI* score > 8, without history of prostate surgery; 62.9 (±8.7) years old (IG^\|\|); 63.0 (±7.4) years old (CG^§).	160 mg S. palmetto capsule (distributed by Rexall-Sundown, Inc), 2x/day (320 mg a day).	Placebo capsule (polyethylene glycol 400, bitter liquid with oily aspect without free fatty acids and brown dye), 2x/day.	12	AUASI*	Qmax^\|\|\|\|\|\|, prostatic volume and PURV	Slight reduction (improvement) in the AUASI* score, 0.72 (±0.35) points in the CG^§ and 0.68 (±0.35) points in the IG^\|\|, but without significant difference between the groups (95% CI**: -0.93 to 1.01). Changes were not observed in Qmax^\|\|\|\|, prostatic volume or PURV.
Barry, et al. (2011)²²; United States of America	PhT^‡	To determine the effect of S. palmetto extract, up to three times the standard dose, in LUTS^‡‡‡ attributed to BPH^¶.	n: 357 IG^\|\|: 176 CG^§: 181	AUASI* score between 8 and 24, without history of prostate surgery; 61.3 ± 8.7 years old (IG^\|\|); 60.7 ± 8.1 years old (CG^§).	320 mg S. palmetto capsule (distributed by Rottapharm). Progressive increase in dosage: -1 capsule/day from the 1^st to the 23^rd week (320 mg a day); -2 capsules/day from the 24^th to the 48^thweek (640 mg a day); -3 capsules/day from the 48^th to the 72^thweek (960 mg a day).	Placebo capsules (375 mg polyethylene glycol, 25 mg glycerol and 75 mg gelatin) following a progressive increase in the number of capsules as in the IG.	18	AUASI*	Qmax^\|\|\|\| and PURV^\|\|\|\|\|\|	The mean AUASI* score decreased (improved) by 2.99 points (95% CI**: -3.81 to -2.17) in the CG and by 2.20 points (95% CI: -3.04 to -0.36) in the IG^\|\|, a difference of 0.79 points between the two groups in favor of the CG^§. The dose-response comparison showed that there was no improvement in the IG^\|\| in any of the doses when compared to the CG^§. Changes were not observed in Qmax and PURV^\|\|\|\|\|\|.
Ye, et al. (2019)²⁶; China	PhT^‡	To assess the efficacy and safety of S. palmetto among patients with LUTS^‡‡‡/ BPH^¶.	n: 325 IG^\|\|: 159 CG^§: 166	BPH^¶ with I-PSS score < 19; 61.5 (±5.2) years old (IG^\|\|); 60.3 (±6.0) years old (CG^§).	160 mg S. palmetto capsule (distributed by Tad Pharma GmbH), 2x/day (320 mg a day).	Placebo capsule (composition not described), 2x/day.	6	I-PSS^††	Qmax^‡‡, prostate volume and urination frequency	The I-PSS^†† score decreased (improved) in both groups, but the reduction was significantly greater after 24 weeks in the IG^\|\| (p < 0.001). The IG ^\|\| presented a significant increase (improvement) in Qmax^‡‡ from the 4^th week (p = 0.011) to the 24^th week (p < 0.001). Changes were not observed in prostate volume or urinary frequency.
Noguchi, et al. (2008)²³; Japan	PhT^‡	To evaluate the safety and efficacy of the Ganoderma lucidum (G. lucidum) extract in men with lower urinary tract symptoms from a dose-escalation study.	n: 50 IG^\|\|/0.6: 12 IG^\|\|/6: 12 IG^\|\|/60: 14 CG^§: 12	I-PSS^†† score > 5 without history of prostate surgery; 59.1 (51-70) years old (IG^\|\|/0.6); 59.2 (50-72) years old (IG^\|\|/6); 59.4 (50-70) years old (IG^\|\|/60); 59.7 (50-67) years old (CG^§).	IG^\|\|/0.6: 0.6 mg G. Lucidum tablet, 1x/day; IG^\|\|/6: 6 mg G. Lucidum tablet, 1x/day; IG^\|\|/60: 60 mg G. Lucidum tablet, 1x/day. (All tablets distributed by Chlorella Industry).	Placebo tablet (83.75% maltitol, 10% corn starch, 3% vitamin C, 0.2% yellow gardenia and 3% sucrose fatty acid ester), 1x/day.	2	I-PSS^††	Qmax^\|\|\|\|, prostatic volume and PURV^\|\|\|\|\|\|	In the 4^th week, the mean change in the I-PSS^†† score was significantly higher in IG^\|\|/60, when compared to the CG^§ (p = 0.012) and to the IG^\|\|/0.6 (p < 0.001). In the 8^th week, the mean change in IG^\|\|/0.6 was significantly lower than in IG^\|\|/6 (p = 0.016) and IG^\|\|/60 (p = 0.005). Slight improvement of Qmax^\|\|\|\|, but without significant differences between the groups. No changes were observed in prostatic volume or PURV^\|\|\|\|\|\|.
Noguchi, et al. (2008)²⁴; Japan	PhT^‡	To evaluate the safety and efficacy in men with mild to moderate lower urinary tract symptoms of the G. Lucidum extract, which showed the highest 5α-reductase inhibitory activity among the extracts of 19 edible and medicinal mushrooms.	n: 88 IG^\|\|_: 44 CG^§: 44	I-PSS^†† score between 5 and 19, with no history of prostate surgery; 64.0 (±6.9) years old (IG^\|\|); 64.0 (±8.0) years old (CG^§).	2 tablets with 3 mg of G. Lucidum (distributed by Chlorella Industry), 1x/day (6 mg a day).	2 placebo tablets (83.75% maltitol, 10% corn starch, 3% vitamin C, 0.2% yellow gardenia and 3% sucrose fatty acid ester), 1x/day.	3	I-PSS^††	Qmax^\|\|\|\|, Qave^‡‡, prostate volume and PURV^\|\|\|\|\|\|	The I-PSS^†† score decreased (improved) more markedly in the IG^\|\| up to the 12^th week, showing a significant difference (p < 0.001) in the mean change in the score between the two groups. Qmax^\|\|\|\| (p = 0.400) and Qave^‡‡ (p = 0.080) showed an increase (improvement) in the IG^\|\| at the 4^th and 8^th weeks, but with no significant difference between the groups at the 12^th week. Changes were not observed in prostate volume or PURV^\|\|\|\|\|\|.
Vidlar, et al. (2010)²⁷; Czech Republic	PhT^‡	To evaluate the efficacy and tolerance of cranberry powder in men with lower urinary tract symptoms, elevated PSA^§§, BPH^¶ and chronic nonbacterial prostatitis.	n: 42 IG^\|\|: 21 CG^§: 21	Histological findings of nonbacterial, acute or chronic prostatitis; 62.0 (±5.4) years old (IG^\|\|); 64.0 (±5.4) years old (CG^§);	500 mg cranberry powder capsule (distributed by Decas Botanical Synergies). 3x/day, (1,500 mg a day).	Placebo capsule (composition not described), 3x/day.	6	I-PSS^††	Qmax, Qave and PURV^\|\|\|\|\|\|	I-PSS^†† score significantly lower (better) in the IG^\|\| when compared to the CG^§ (p < 0.050). Significant improvement (p < 0.050) of Qmax^\|\|\|\|, Qave^‡‡ and PURV^\|\|\|\|\|\| in at least 70% of the IG participants^\|\|, and significant worsening (p < 0.050) of PURV^\|\|\|\|\|\| in the CG^§.
Vidlar, et al. (2015)²⁸; Czech Republic	PhT^‡	To evaluate the effect of cranberry in men with moderate to severe lower urinary tract symptoms.	n: 122 IG^\|\|/500: 38 IG^\|\|/250: 43 CG^§: 41	I-PSS^†† score > 8 without history of prostate surgery; 52.5 (±5.4) years old (IG^\|\|/500); 53.3 (±5.2) years old (IG^\|\|/250); 54.0 (±5.1) years old (CG^§).	IG^\|\|/500: 2 x 250 mg cranberry capsules 1x/day (500 mg a day); IG^\|\|/250: 1 250 mg cranberry capsule and 1 placebo capsule, 1x/day (250 mg a day); (all capsules distributed by Decas Botanical Synergies).	2 placebo capsules (low density maltodextrin, canola oil, sodium aluminum silicate, lake red 40 and lake blue 1), 1x/day.	6	I-PSS^††	Qmax^\|\|\|\|, Qave^‡‡, PURV^\|\|\|\|\|\| and bladder emptying volume	Significant reductions (improvement) in the I-PSS^†† score of IG^\|\|/500 and IG^\|\|/250, of -4.1 (±1.9) (p < 0.001) and -3.1 (±3.0) (p = 0.050) points respectively. Qmax^\|\|\|\| (p = 0.018), Qave^‡‡ (p = 0.040), PURV^\|\|\|\|\|\| (p = 0.027) and bladder emptying volume (p = 0.014) significantly improved in IG^\|\|/500.
Johnstone, et al. (2003)²⁰; United States of America	EA^†	To assess the response of lower urinary tract symptoms and PSA^§§ to EA^† in a population of patients with a negative biopsy for prostate cancer.	n: 30 (It does not specify the sample in each study group)	I-PSS^†† score > 8; 60.7 (±8.2) years old (IG^\|\|); 64.7 (±5.2) years old (CG^§/EA^† placebo); 63.5 (±3.4) years old (CG^§/observation).	AcPts***: R10, B40, B32 and B10. 4-5 Hz electrostimulation on R10 and B40. Sessions 3x/week in the 1^st and 2^nd weeks, and later 1x/week in the 3^rd, 4^th and 8^th weeks, 20 min/session.	CG^§/EA^† placebo: insertion of 5 needles in the posterior region of the shoulders, areas unrelated to AcPts*** and without electrostimulation. CG^§/observation: no intervention during the study.	3 (9 sessions)	I-PSS^††	Not evaluated	No changes were observed in the I-PSS^†† score (p = 0.063).
Ricci, et al. (2004)²⁹; Italy	EA^†	To assess whether EA^† in reflex therapy/acupuncture is able to treat the sensory irritating components of lower urinary tract symptoms that persist after TURP^†††	n: 42 IG^\|\|:13 CG^§/ placebo: 14 CG^§/ conv: 15	Persistence of sensory irritative symptoms of the lower urinary tract after TURP^†††; 64.76 years old (52-78 years old).	Somatic AcPts: Conception vessel: 1, 2, 4, 5; Bladder 21, 23 and 32; Auricular AcPts***: prostate and external genitalia. 5-10 Hz electrostimulation, with greater intensity tolerated by the patient. 3 sessions/week, plus maintenance sessions every 15 days, starting from the 4^th week, 20 min/session.	CG^§/placebo: placebo tablet (it does not define composition, number of tablets, or repetitions per day); CG^§/conv: Oxybutynin 5 mg tablet, 2x/day (10 mg a day).	3 (12 sessions)	I-PSS^††	Qmax^\|\|\|\|, prostate volume, urination frequency and nocturia	The I-PSS score^†† decreased (improved) in the CG^§ and IG^\|\| during the first 3 months, but the difference was only significant in the IG^\|\| (p<0.001). Changes were not observed in Qmax^\|\|\|\| and prostate volume. Reductions in daytime urination frequency of 20% and 8% in the IG^\|\| and CG^§, respectively. The nocturia reports were also reduced 60% and 20% in the IG^\|\| and CG^§, respectively.
Yu, et al. (2011)³⁰; Taiwan	EA^†	To evaluate the effect of EA^† on lower urinary tract symptoms in men with BPH^¶.	n: 37 IG^\|\|: 18 CG^§: 19	BPH^¶ confirmed by transrectal US^§§§ with I-PSS^†† score > 8, with no history of prostate surgery; 63.2 (±10.0) years old (IG^\|\|); 59.8 (±9.0) years old (CG^§).	AcPts***: Conception Vessels 3 and 4; Stomach 36 and Spleen-Pancreas 6. Needles inserted and handled for 3-5 minutes until reaching Qi. 2 Hz electrostimulation with 2-2.5 mA intensity. 2 sessions/week, 20 min/session.	Needles inserted superficially (subcutaneous tissue), 1 cm lateral to the AcPt*** of the IG^\|\|, without manual handling or electrostimulation. Same frequency of sessions as in the IG^\|\|.	1.5 (12 sessions)	I-PSS^††	Qmax^\|\|\|\|,Qave^‡‡ and bladder emptying volume	Changes were not observed in the I-PSS^†† score between the groups. Increase (improvement) in Qmax^\|\|\|\| (p = 0.030), Qave^‡‡ (p = 0.026), significant emptying volume (p = 0.038) in the IG^\|\|.
Wang, et al. (2013)²⁵; China	EA^†	To evaluate the effects of EA^† on the I-PSS^†† score, PURV^\|\|\|\|\|, and Qmax^\|\|\|\|, as well as to explore the differences between AE^† in AcPts*** and unrelated points in patients with moderate or severe BPH^¶.	n: 100 IG^\|\|: 50 CG^§: 50	BPH^¶ determined by I-PSS^†† score > 8; 64.8 (±7.1) years old (IG^\|\|); 65.9 (±6.7) years old (CG^§);	AcPts***: Bladder 33, with manipulation until the patient feels a sensation of weight and numbness. 20 Hz electrostimulation, with maximum intensity tolerated by the patient. 1 session/day completing 5 sessions/week during the 1^st and 2^nd weeks, and then 3 sessions/week in the 3^rd and 4^th weeks	Needles inserted at two points approximately 6.7 cm lateral to the AcPts***, without manipulation, with the same electrostimulation as in the intervention group. Same frequency of sessions as in the IG^\|\|.	1 (16 sessions)	I-PSS^††	Qmax^\|\|\|\| and PURV^\|\|\|\|\|\|	The I-PSS^†† score had a 3.2-point higher reduction (improvement) in the IG^\|\| than in the CG^§at week 18 (p = 0.001). No changes were observed in Qmax^\|\|\|\| or PURV^\|\|\|\|\|.

Author, year	Q1^\|\|	Q2^\|\|	Q3^\|\|	Q4^\|\|	Q5^\|\|	Q6^\|\|	Q7^\|\|	Q8^\|\|	Q9^\|\|	Q10^\|\|	Q11^\|\|	Q12^\|\|	Q13^\|\|	Total	Risk of bias
Gerber, et al., 2001¹⁹	Y*	Y*	Y*	Y*	Y*	U^‡	Y*	N^†	N^†	Y*	Y*	Y*	Y*	76.92%	Low
Bent, et al., 2006²¹	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	100%	Low
Barry, et al., 2011²²	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	100%	Low
Ye, et al., 2019²⁶	U^‡	U^‡	N^†	U^‡	U^‡	U^‡	Y*	N^†	Y*	Y*	Y*	Y*	Y*	46.15%	High
Noguchi, et al., 2008²³	Y*	Y*	Y*	Y*	Y*	N^†	Y*	Y*	Y*	Y*	Y*	Y*	Y*	92.31%	Low
Noguchi, et al., 2008²⁴	Y*	Y*	Y*	Y*	Y*	N^†	Y*	Y*	Y*	Y*	Y*	Y*	Y*	92.31%	Low
Vidlar, et al., 2010²⁷	U^‡	U^‡	N^†	U^‡	U^‡	U^‡	Y*	N^†	N^†	Y*	Y*	Y*	Y*	38.46%	High
Vidlar, et al., 2015²⁸	Y*	Y*	Y*	Y*	U^‡	U^‡	Y*	N^†	N^†	Y*	Y*	Y*	Y*	69.23%	Moderate
Johnstone, et al., 2003²⁰	Y*	U^‡	Y*	NA^§	NA^§	U^‡	Y*	N^†	N^†	Y*	Y*	Y*	Y*	53.85%	Moderate
Ricci, et al., 2004²⁹	U^‡	U^‡	N^†	NA^§	NA^§	U^‡	Y*	N^†	N^†	Y*	Y*	Y*	Y*	38.46%	High
Yu, et al., 2011³⁰	Y*	Y*	Y*	Y*	NA^§	U^‡	Y*	N^†	N^†	Y*	Y*	Y*	Y*	69.23%	Moderate
Wang, et al., 2013²⁵	Y*	Y*	Y*	Y*	NA^§	Y*	Y*	Y*	Y*	Y*	Y*	Y*	Y*	92.31%	Low

[TFN3] *AUASI = American Urological Association Symptom Index; ^†EA = Allethroacupuncture; ^‡Ph = Phytotherapy; ^§CG = Control Group; ^||IG = Intervention Group; ^¶BPH = Benign Prostate Hyperplasia; **CI = Confidence Interval; ^††I-PSS = International Prostate Symptom Score; ^‡‡Qave =Average Urinary Flow Rate; ^§§PSA = Prostate-Specific Antigen; ^||||Qmax = Peak Urinary Flow Rate; ^¶¶CTs = Complementary Therapies; ***AcPts = Acupuncture Points; ^†††TURP = Transurethral Resection of the Prostate; ^‡‡‡LUTS = Lower Urinary Tract Symptoms; ^§§US = Ultrasound; ^||||||PURV = Post-Urination Residual Volume.