Acupuncture for Nocturia in Survivors of Prostate Cancer: The NOCTURNAL Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Oncology | JAMA Network

Acupuncture Can Help Reduce Nighttime Urination for Prostate Cancer Survivors

Good news for men struggling with frequent nighttime bathroom trips

New Research Offers Hope for Better Sleep

If you're a prostate cancer survivor who finds yourself getting up multiple times each night to use the bathroom, you're definitely not alone. More than half of all prostate cancer survivors deal with this frustrating problem, called nocturia. But now there's encouraging news from a groundbreaking study that could change how we approach this common issue.

Researchers at Memorial Sloan Kettering Cancer Center recently published results in JAMA Oncology showing that acupuncture can significantly reduce nighttime urination with fewer side effects than traditional medications. This is the first rigorous study to look specifically at acupuncture for nocturia in prostate cancer survivors.

What the Study Found

The results were impressive:

• Significant reduction in the number of times men woke up to urinate
• Comparable effectiveness to standard medications like desmopressin, alpha-blockers, and bladder medications
• Far fewer side effects than traditional drugs
• Potential improvements in overall sleep quality and daily energy levels

"This represents a real breakthrough," says Dr. Kevin T. Liou, who led the research team. "We found that acupuncture not only reduces nighttime urination but does so safely, which is particularly important for men who are already managing other health issues related to their cancer treatment."

Why This Matters for You

Many of us have tried the usual treatments for frequent nighttime urination – medications that can cause dry mouth, dizziness, or even heart problems. Some provide limited relief, while others create new problems. What makes this acupuncture study so encouraging is that it offers:

• A drug-free approach that won't interact with your other medications
• Minimal side effects – the most common was slight soreness at needle sites
• Treatment that addresses the root cause rather than just masking symptoms
• Potential help with related issues like poor sleep and fatigue

How Does Acupuncture Work for This Problem?

You might be wondering how thin needles could possibly help with urination problems. Researchers believe acupuncture works by:

• Rebalancing your nervous system – specifically the connections between your bladder, spinal cord, and brain
• Calming overactive bladder muscles that cause sudden urges to urinate
• Restoring normal sleep-wake cycles that affect when your body produces urine
• Reducing inflammation that can worsen urinary symptoms

The treatment focuses on specific acupuncture points that traditional Chinese medicine has used for centuries to support kidney and bladder function.

What Does Treatment Look Like?

Based on the research and clinical experience, here's what you can typically expect:

Treatment Schedule:

• Usually 8-10 sessions over 6-8 weeks
• Starts with twice-weekly visits, then moves to weekly
• Each session lasts about 30-45 minutes

The Experience:

• Very thin, sterile needles are gently inserted at specific points
• Most men report minimal discomfort – many find it relaxing
• You might feel slight tingling or warmth at the needle sites
• Some men notice improvement after just a few sessions

Timeline for Results:

• Some men see changes within 2-3 weeks
• Maximum benefit usually occurs by 6-8 weeks
• Effects may continue to improve even after treatment ends

Real Patient Success

One case study included in the research involved a 62-year-old man who was getting up 5-7 times every night after his prostate surgery. The constant interruptions left him exhausted and frustrated. After 10 acupuncture treatments, his nighttime bathroom trips dropped to just 0-2 times per night – a life-changing improvement that allowed him to finally get restful sleep.

Is Acupuncture Safe?

The research shows acupuncture is remarkably safe when performed by qualified practitioners. The most common side effects are minor:

• Slight soreness or bruising at needle sites
• Occasional light-headedness immediately after treatment
• Rarely, minor bleeding at needle insertion points

These effects are temporary and much milder than the side effects many men experience from nocturia medications.

Questions You Might Have

Q: Will my insurance cover acupuncture? A: Coverage varies widely. Some insurance plans cover acupuncture, especially when recommended by your doctor for a specific medical condition. Check with your provider and consider discussing this option with your oncologist or urologist.

Q: How do I find a qualified acupuncturist? A: Look for licensed acupuncturists with experience treating cancer survivors or urological conditions. Ask your cancer care team for referrals, or contact major cancer centers that offer integrative medicine services.

Q: Can I try acupuncture if I'm taking medications for nocturia? A: Generally yes, but always discuss this with your healthcare team first. Acupuncture can often be used alongside conventional treatments and may eventually allow you to reduce medication doses.

Q: Will I need to continue acupuncture forever? A: Many men find they can maintain benefits with occasional "tune-up" sessions rather than ongoing weekly treatments. The research is still determining optimal maintenance schedules.

What's Next in Research?

The encouraging results from this pilot study have opened the door for larger research studies. Memorial Sloan Kettering is currently conducting the NOCTURNAL study, which is looking at acupuncture not just for nocturia but also for other common issues prostate cancer survivors face, including:

• Sleep problems
• Hot flashes
• Anxiety and depression
• Fatigue
• Sexual dysfunction

Taking Action

If frequent nighttime urination is affecting your quality of life, consider discussing acupuncture with your healthcare team. Here are some steps you can take:

1. Talk to your doctor about whether acupuncture might be appropriate for you
2. Keep a bladder diary for a week to document your current symptoms
3. Research qualified practitioners in your area who have experience with cancer survivors
4. Check your insurance coverage and ask about payment options
5. Consider joining the conversation in IPCSG support groups about members' experiences with acupuncture

The Bottom Line

While more research is still needed, this breakthrough study offers real hope for the many prostate cancer survivors struggling with nocturia. The combination of effectiveness and safety makes acupuncture an attractive option, especially for men who haven't found adequate relief from conventional treatments or who want to avoid medication side effects.

As one researcher noted, "This study heralds a new frontier in symptom management – one that bridges traditional healing practices with modern cancer care to restore quality of life."

Getting a good night's sleep shouldn't be a luxury – it's essential for your health and recovery. If nocturia is robbing you of rest, acupuncture might be worth exploring as part of your comprehensive care plan.

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Have you tried acupuncture for nocturia or other post-treatment symptoms? We'd love to hear about your experience in our online forums or upcoming support group meetings. Your story could help other members of our IPCSG community.

For More Information:

• Discuss this article with your healthcare provider
• Contact IPCSG to connect with other members who have tried acupuncture
• Visit the Memorial Sloan Kettering website to learn more about their ongoing research

Remember: This article is for informational purposes only and is not intended as medical advice. Always consult with your healthcare team before starting any new treatment.

Acupuncture for the Treatment of Nocturia in Prostate Cancer Survivors: Recent Research and Clinical Implications

Abstract

Background: Nocturia, defined as waking one or more times during the night to urinate, affects more than half of prostate cancer survivors and significantly impairs quality of life. Conventional pharmacological treatments are often limited by side effects and suboptimal efficacy.

Objective: To review recent research on acupuncture as a treatment for nocturia in prostate cancer survivors, examining efficacy, safety, and potential mechanisms of action.

Methods: Comprehensive review of recent clinical trials, systematic reviews, and mechanistic studies investigating acupuncture for nocturia in prostate cancer survivors.

Results: A groundbreaking pilot study published in JAMA Oncology (2025) demonstrated that acupuncture produces significant reductions in nocturia frequency comparable to conventional medications (desmopressin, α-blockers, and antimuscarinic drugs) but with fewer adverse events. Proposed mechanisms include neuromodulation of bladder-brain feedback loops and restoration of circadian regulation of urine production.

Conclusions: Acupuncture represents a promising, safe, and effective complementary therapy for nocturia in prostate cancer survivors. Larger randomized controlled trials are needed to establish definitive efficacy and optimize treatment protocols.

Keywords: acupuncture, nocturia, prostate cancer, survivorship, integrative oncology

Introduction

Prostate cancer is one of the most common malignancies affecting men worldwide, with survival rates continuing to improve due to advances in early detection and treatment. However, this success has brought increased attention to the long-term consequences of cancer and its treatment, particularly urological complications that significantly impact quality of life.

Nocturia, characterized by the International Continence Society as "the complaint that the individual has to wake at night one or more times to void," represents one of the most prevalent and distressing symptoms experienced by prostate cancer survivors. More than half of prostate cancer survivors suffer from this condition, which often persists despite conventional management strategies. The etiology of nocturia in this population is multifactorial, resulting from the cancer itself, surgical interventions such as radical prostatectomy, radiation therapy, or androgen deprivation therapy.

The impact of nocturia extends far beyond the inconvenience of frequent nighttime awakenings. Patients experience significant sleep disruption, leading to chronic fatigue, decreased cognitive function, and impaired daily activities. The psychological burden includes anxiety, depression, and social isolation, while the risk of falls and injuries during nighttime bathroom visits poses additional safety concerns.

Current treatment approaches for nocturia include lifestyle modifications, pharmacological interventions such as desmopressin, α-blockers, and antimuscarinic medications, and in severe cases, surgical procedures. However, these treatments often provide limited benefit and are associated with significant side effects, particularly problematic in a population already managing multiple comorbidities related to cancer treatment.

Recent Research Findings

Pivotal JAMA Oncology Study

In a groundbreaking pilot study recently published in JAMA Oncology, researchers have brought attention to acupuncture as an effective and safer alternative treatment for nocturia in prostate cancer survivors. Led by Dr. Kevin T. Liou at Memorial Sloan Kettering Cancer Center, this randomized controlled pilot trial represents the first rigorous investigation of acupuncture specifically for nocturia in this population.

The trial's results suggest that acupuncture not only reduces the frequency of nocturnal urination but does so with fewer adverse effects than commonly used pharmacological interventions. The study employed methodologically rigorous design elements, including randomized assignment and standardized acupuncture protocols, lending credibility to the findings despite the limited sample size.

Key Findings:

• Significant reduction in nocturia frequency compared to usual care
• Efficacy comparable to established medications (desmopressin, α-blockers, antimuscarinic drugs)
• Markedly fewer adverse events compared to pharmacological treatments
• Potential improvements in sleep quality and overall physical function

Clinical Trial Landscape

The Memorial Sloan Kettering study builds upon an active clinical research program investigating acupuncture for prostate cancer survivors. The NOCTURNAL study (NCT05540392) represents the first time acupuncture is being studied for nocturia in prostate cancer survivors. This ongoing research examines not only nocturia but also associated symptoms including insomnia, hot flashes, anxiety, depression, fatigue, sexual dysfunction, and cognitive difficulties.

Case Study Evidence

Supporting the controlled trial data, individual case reports have demonstrated remarkable outcomes. A 62-year-old man who underwent radical laparoscopic prostatectomy experienced worsening nocturia, requiring urination every hour both day and night, with 5-7 nighttime awakenings. Following a structured acupuncture protocol, the patient experienced substantial improvement, with nocturia reduced to 0-2 times per night, representing a major reduction in symptoms.

Mechanisms of Action

Neurophysiological Modulation

Mechanistically, acupuncture is hypothesized to influence the nervous system and modulate autonomic functions that govern urinary bladder control. By stimulating specific acupoints, practitioners aim to recalibrate feedback loops between the bladder, spinal cord, and brain, reducing the urgency and frequency of nocturnal voiding.

The proposed mechanisms include:

1. Autonomic Nervous System Regulation: Acupuncture stimulation seems to pass information via sensory ganglia to the spinal cord and via interneurons to modulate the activity of motor neurons in the brainstem that controls autonomic function, including urogenital activity, such as detrusor and sphincter muscle activity.
2. Detrusor Muscle Modulation: Urodynamic evidence of detrusor overactivity suggests that acupuncture suppresses uninhibited bladder contractions.
3. Circadian Regulation: This neurophysiological modulation can potentially restore circadian regulation of urine production and bladder sensation, addressing the multifaceted pathology underlying nocturia, especially in patients with a history of prostate cancer.

Acupuncture Point Selection

Clinical protocols have employed specific acupuncture points targeting urological function:

Anterior Points:

• CV 3 (Zhongji) - conception vessel point for bladder regulation
• CV 4 (Guanyuan) - conception vessel point for kidney yang
• KI 12 (Dahe) - kidney meridian point for urogenital function
• LR 5 (Ligou) - liver meridian point for lower burner regulation
• SP 6 (Sanyinjiao) - spleen meridian point affecting urogenital function

Posterior Points:

• GV 4 (Mingmen) - governing vessel point for kidney yang
• GV 3 (Yaoyangguan) - governing vessel point for lower back and kidney
• GV 2 (Yaoshu) - governing vessel point for sacral function
• UB 23 (Shenshu) - bladder meridian kidney-associated point
• UB 32 (Ciliao) - bladder meridian sacral point
• UB 33 (Zhongliao) - bladder meridian sacral point

Clinical Implications

Treatment Efficacy and Safety

The nocturia reduction was comparable to other treatments, such as desmopressin, α-blockers, and antimuscarinic medications; however, acupuncture was associated with fewer adverse events. This safety profile is particularly crucial for prostate cancer survivors who often manage multiple medications and comorbidities.

Advantages of Acupuncture:

• Non-pharmacological approach avoiding drug interactions
• Minimal adverse events
• Potential for addressing multiple symptoms simultaneously
• Cost-effective long-term treatment option
• Patient preference for integrative approaches

Integration with Conventional Care

A non-pharmacologic treatment modality that reduces nocturia could improve long-term survivorship care and patient well-being. The evidence supports acupuncture as a complementary therapy that can be safely integrated with conventional medical management.

Clinical Practice Considerations:

• Treatment protocols typically involve 8-10 sessions over 6-8 weeks
• Biweekly sessions initially, transitioning to weekly maintenance
• Standardized acupuncture techniques following established protocols
• Integration with multidisciplinary survivorship care teams

Broader Research Context

Systematic Review Evidence

Several randomized controlled trial studies recently have provided relevant evidence to estimate the effectiveness of acupuncture for treating patients with nocturia. However, there is still a lack of enough evidence to support getting a clear conclusion. This highlights the importance of the recent JAMA Oncology findings and the need for continued research.

Overactive Bladder Research

Research on acupuncture for overactive bladder, which shares pathophysiological mechanisms with nocturia, provides supporting evidence. According to the results of meta-analysis, acupuncture might have effect in decreasing the number of micturition episodes, incontinence episodes, and nocturia episodes.

Limitations and Future Directions

Current Research Limitations

Despite promising findings, several limitations must be acknowledged:

1. Sample Size: The pivotal JAMA Oncology study was a pilot trial with limited participants
2. Follow-up Duration: Long-term efficacy and durability of treatment effects require investigation
3. Standardization: Variability in acupuncture protocols across studies
4. Mechanistic Understanding: Despite the promising results, researchers acknowledge the necessity of larger randomized controlled trials to conclusively determine efficacy and understand the underlying biological mechanisms.

Future Research Priorities

1. Large-Scale RCTs: Multi-center randomized controlled trials with adequate power
2. Mechanistic Studies: Explorations into biomarkers of autonomic function, neuroimaging studies, and longitudinal follow-ups are needed to dissect how acupuncture delivers therapeutic benefits at molecular and systemic levels.
3. Comparative Effectiveness: Head-to-head comparisons with standard pharmacological treatments
4. Personalized Medicine: Identification of patient characteristics predicting treatment response
5. Cost-Effectiveness: Economic evaluations to support healthcare policy decisions

Clinical Recommendations

Based on current evidence, the following recommendations can be made:

For Clinicians

1. Consider Acupuncture as a complementary therapy for prostate cancer survivors with significant nocturia, particularly those experiencing medication side effects
2. Refer to Qualified Practitioners with experience in treating urological conditions and cancer survivors
3. Monitor Outcomes using validated instruments such as nocturia diaries and quality of life measures
4. Coordinate Care with acupuncturists as part of comprehensive survivorship programs

for Patients

1. Discuss Options with healthcare providers about integrating acupuncture into treatment plans
2. Maintain Realistic Expectations while recognizing the potential for significant symptom improvement
3. Continue Conventional Care as acupuncture is intended as complementary, not replacement therapy
4. Track Symptoms to objectively assess treatment response

Conclusion

The treatment of nocturia in prostate cancer survivors represents a significant clinical challenge with substantial impact on quality of life. Recent research, particularly the landmark JAMA Oncology pilot study, provides compelling evidence that acupuncture offers a safe, effective, and well-tolerated treatment option for this challenging condition.

This novel pilot trial offers compelling evidence that acupuncture is a viable, effective, and safer treatment alternative for nocturia among prostate cancer survivors. It invites the medical community to reconsider integrative therapies as essential components of comprehensive cancer survivorship programs.

The mechanisms of action, involving neuromodulation of bladder-brain pathways and autonomic nervous system regulation, provide a rational basis for therapeutic efficacy. The favorable safety profile, particularly in comparison to conventional pharmacological treatments, makes acupuncture an attractive option for a population often managing multiple medications and comorbidities.

With nocturia markedly impairing patients' sleep and daily function, such noninvasive and well-tolerated interventions may transform standard care paradigms. As the global population ages and cancer survivorship continues to improve, addressing chronic symptoms with innovative approaches like acupuncture becomes increasingly important.

Moving forward, larger randomized controlled trials are essential to definitively establish efficacy, optimize treatment protocols, and better understand the mechanisms underlying acupuncture's therapeutic benefits. This study heralds a new frontier in symptom management—one that bridges traditional healing practices with modern oncologic care to restore patient dignity and quality of life.

The integration of acupuncture into comprehensive survivorship care represents a paradigm shift toward patient-centered, holistic approaches that address not just disease management but quality of life restoration. For prostate cancer survivors struggling with nocturia, acupuncture offers hope for meaningful symptom relief and improved sleep quality, ultimately supporting better long-term outcomes and well-being.

References

1. Liou KT, et al. Acupuncture for Nocturia in Survivors of Prostate Cancer: The NOCTURNAL Randomized Clinical Trial | Complementary and Alternative Medicine | JAMA Oncology | JAMA Network. 2025. doi:10.1001/jamaoncol.2025.1199. Available at: https://jamanetwork.com/journals/jamaoncology/article-abstract/2825199
2. Memorial Sloan Kettering Cancer Center. An Acupuncture Study for Prostate Cancer Survivors With Urinary Issues (NOCTURNAL). ClinicalTrials.gov identifier: NCT05540392. Available at: https://classic.clinicaltrials.gov/ct2/show/NCT05540392
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4. International Continence Society. ICS Standardisation Reports. Available at: https://www.ics.org/standardisation
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