Medical Acupuncture in Prostate Cancer Care - Managing ADTRelated Hot Flushes and Wellbeing: Evidence-Based Supportive Care Approach after Radiotherapy and Chemotherapy

Abstract

Androgen Deprivation Therapy (ADT) remains the cornerstone of systemic treatment for locally advanced and metastatic prostate cancer, with over 50,000 men in the UK currently receiving long-term ADT. While effective at suppressing testosterone and controlling disease, ADT is associated with significant treatment-related toxicities most notably severe hot flushes experienced by 60–80% of recipients — alongside fatigue, sleep disturbance, sexual dysfunction, mood changes, and reduced quality of life. These adverse effects are compounded by the additional physiological and psychological burdens of radiotherapy and chemotherapy, contributing to high rates of non-adherence and treatment discontinuation. Conventional management of hot flushes includes venlafaxine, gabapentin, and hormonal agents, which provide only partial relief and carry their own side effect profiles, creating an unmet need for safe, effective, and well-tolerated supportive interventions. This narrative review evaluates the evidence base, mechanisms of action, and clinical application of medical acupuncture as an integrated supportive care intervention in prostate cancer, with specific focus on ADT-related hot flushes, symptom burden, and overall wellbeing following radiotherapy and chemotherapy. Drawing on randomised controlled trials, systematic reviews, meta-analyses, and international clinical guidelines, this paper synthesises current evidence and proposes an evidence-informed clinical protocol for implementation within UK oncology practice. Medical acupuncture modulates hot flushes through multiple complementary pathways: regulation of central thermoregulatory centres in the hypothalamus; stimulation of β-endorphin and serotonin release; reduction of sympathetic nervous system overactivity; improvement of sleep quality and autonomic balance; and modulation of inflammatory cytokine profiles elevated by cancer treatment and ADT. High-quality clinical evidence — including three Cochrane reviews and a 2024 individual patient data meta-analysis — demonstrates that acupuncture significantly reduces hot flush frequency by 30–50% and severity by 40–60%, with effects comparable to pharmaceutical interventions but superior tolerability and sustained benefit persisting 3–6 months posttreatment. Acupuncture also demonstrates significant benefit for cancer-related fatigue, sleep disturbance, anxiety, pain, and overall quality of life, with emerging evidence for improved sexual function and bone health. National and international guidelines increasingly recognise acupuncture as a valid supportive care option: the American Society of Clinical Oncology (ASCO) and Society for Integrative Oncology (SIO) recommend acupuncture for hot flushes and cancer-related fatigue; the British Medical Acupuncture Society (BMAS) provides specific guidance for oncology practice; and the National Institute for Health and Care Excellence (NICE) acknowledges acupuncture as a consideration for supportive care where evidence supports clinical benefit. Importantly, acupuncture is safe when delivered by appropriately trained practitioners, with no known interactions with ADT, chemotherapy, or radiotherapy, and no increased risk of bleeding or infection in appropriately selected patients. In conclusion, medical acupuncture represents a robust, evidence-based, and well-tolerated supportive care intervention that addresses multiple dimensions of the prostate cancer treatment experience. By integrating acupuncture alongside conventional oncology care, clinicians can improve symptom control, enhance treatment adherence, reduce the burden of adverse effects, and support the holistic wellbeing of men living with and beyond prostate cancer. Further largescale UK-based trials and implementation research are warranted to support commissioning and routine integration within NHS prostate cancer care pathways.