New Hope for Nighttime Urination

Acupuncture Shows Promise for Prostate Cancer Survivors

Latest research reveals effective non-drug treatment option for one of the most common survivorship challenges

More than half of prostate cancer survivors experience nocturia—waking up multiple times at night to urinate—a condition that significantly impacts sleep quality, mood, and overall quality of life. For many men, this frustrating symptom persists long after their cancer treatment has ended, sometimes becoming a lifelong challenge that affects their ability to enjoy restful sleep.

Groundbreaking Clinical Trial Results

In a significant development for prostate cancer survivorship care, researchers at Memorial Sloan Kettering Cancer Center have published the first randomized clinical trial specifically examining acupuncture as a treatment for nocturia in prostate cancer survivors. The NOCTURNAL trial, published in JAMA Oncology in July 2025, offers new hope for men struggling with this persistent side effect.

The pilot study enrolled 60 men who had been treated for prostate cancer and were experiencing two or more episodes of nocturia per night. Participants had received various treatments including surgery, external-beam radiation, brachytherapy (radioactive seeds), and/or hormone therapy, enrolling in the trial an average of eight years after completing their cancer treatment.

Impressive Clinical Outcomes

The results were striking. Men who received weekly acupuncture treatments for 10 weeks experienced an average reduction of approximately one nighttime urination episode compared to those receiving usual care. More encouragingly, these benefits persisted for at least one month after treatment ended.

Key findings include:

  • Significant reduction in nocturia episodes: The acupuncture group showed a 1.08 episode decrease versus 0.05 in the control group (P < 0.001)
  • Improved overall urinary symptoms: International Prostate Symptom Score (IPSS) total scores improved by 3.64 points in the acupuncture group versus 0.12 in controls (P = 0.002)
  • Sustained benefits: Improvements remained significant one month post-treatment
  • Minimal side effects: Only mild adverse events like dizziness and insomnia were reported, with no serious complications

Treatment Protocol and Safety Profile

The acupuncture treatments used both manual and electroacupuncture techniques, targeting specific points on the back, lower limbs, and ears. The main acupuncture points included BL23, BL28, BL31, BL33, BL35, BL40, KI3, KI7, SP6, and ear points for kidney and bladder function. Electroacupuncture was applied for 20-30 minutes at frequencies of 2-10 Hz.

Dr. Kevin Liou, the study's lead author and integrative medicine specialist at MSK, emphasized the clinical significance: "Even though this was a small study, it suggests that acupuncture can help men who have received prostate cancer treatment by reducing the number of times they wake up at night to urinate. More research is needed, but these findings are a promising start."

Understanding the Scope of the Problem

The timing of this research is particularly important given the prevalence of nocturia among prostate cancer survivors. Approximately 50% of men experience acute genitourinary symptoms following radiation therapy, with nocturia being the most common complaint. Previous research has shown that nocturia can be associated with:

  • Radical prostatectomy procedures
  • Radiation therapy side effects
  • Androgen deprivation therapy (ADT)
  • Age-related changes in urinary function
  • Genetic factors affecting radiation response

Beyond Conventional Treatments

This research represents a shift toward integrative approaches in cancer survivorship care. Traditional treatments for nocturia include medications like desmopressin and antimuscarinics, but these often come with significant side effects including dizziness, dry mouth, constipation, and cognitive impairment—particularly concerning for older patients.

The NOCTURNAL trial's focus on acupuncture aligns with growing interest in non-pharmacological interventions that can improve quality of life without adding to patients' medication burden.

Behavioral Strategies Also Important

While waiting for larger studies to confirm acupuncture's benefits, experts continue to emphasize evidence-based behavioral strategies for managing nocturia:

Fluid Management:

  • Stop significant liquid intake three hours before bedtime
  • Front-load hydration during morning and early afternoon hours
  • Use minimal water when taking evening medications

Dietary Considerations:

  • Avoid natural diuretics (celery, cucumbers, asparagus) at dinner
  • Finish last major meal 3-4 hours before bedtime
  • Limit alcohol and caffeine in the evening

Sleep Environment Optimization:

  • Maintain bedroom temperature between 65-68°F (18-20°C)
  • Wear breathable fabrics like cotton or bamboo
  • Ensure proper room ventilation

Pre-sleep Routine:

  • Practice "double voiding" technique before bed
  • Elevate legs 1-2 hours before bedtime to reduce fluid retention
  • Consider left-side sleeping position with pillow between knees

Looking Ahead: Research and Clinical Practice

The NOCTURNAL trial, while promising, was a small pilot study requiring larger confirmation studies. The acupuncture community has recognized this work as groundbreaking—the first trial specifically targeting post-prostate cancer nocturia. Dr. Maria Chiara Masone, writing in Nature Reviews Urology, highlighted its importance in addressing "a major unmet need for prostate cancer survivors."

Clinical Practice Implications: For prostate cancer survivors experiencing nocturia, this research suggests acupuncture could be worth discussing with healthcare providers. The treatment showed benefits regardless of cancer treatment type, making it potentially applicable to a broad range of survivors—including men who received ADT, a group known for more severe symptoms.

Next Steps for Patients:

  • Consult oncology teams before starting new treatments
  • Seek certified acupuncturists with cancer care experience
  • Discuss potential interactions with current medications
  • Set realistic expectations about treatment timelines

The Bottom Line

The NOCTURNAL trial represents meaningful progress in prostate cancer survivorship care, offering evidence for a safe, non-drug approach to managing one of treatment's most persistent side effects. As Dr. Liou noted, this research "opens the door to conversations about personalized, less invasive treatment options aligned with patient preferences and well-being."

For men who've endured cancer and its treatments, the prospect of restful sleep could indeed make a world of difference. While larger studies are needed, these initial results provide tangible hope for millions of prostate cancer survivors worldwide struggling with disrupted sleep.

Sources and References

  1. Liou, K.T., Carlsson, S., Ajay, D., et al. (2025). Acupuncture for Nocturia in Survivors of Prostate Cancer: The NOCTURNAL Randomized Clinical Trial. JAMA Oncology, 11(7), 791-794. doi: 10.1001/jamaoncol.2025.1199. URL: https://jamanetwork.com/journals/jamaoncology/article-abstract/2834640
  2. Masone, M.C. (2025). Acupuncture to reduce nocturia in survivors of prostate cancer. Nature Reviews Urology, 22, 409. doi: 10.1038/s41585-025-01059-x. URL: https://www.nature.com/articles/s41585-025-01059-x
  3. Memorial Sloan Kettering Cancer Center. (2025, June 18). MSK Research Highlights, June 18, 2025. URL: https://www.mskcc.org/news/msk-research-highlights-june-18-2025
  4. Medical Xpress. (2025, June 4). Acupuncture may alleviate nocturia in men treated for prostate cancer. URL: https://medicalxpress.com/news/2025-06-acupuncture-alleviate-nocturia-men-prostate.html
  5. Medindia. (2025, June 17). Acupuncture May Ease Nocturia in Prostate Cancer Survivors. URL: https://www.medindia.net/news/acupuncture-may-ease-nocturia-in-prostate-cancer-survivors-220155-1.htm
  6. British Medical Acupuncture Society. (2025, June 2). EA for nocturia 2025 – The BMAS Blog. URL: https://bmas.blog/2025/06/02/ea-for-nocturia-2025/
  7. ZERO Prostate Cancer. (2024-2025). Advanced Prostate Cancer Newsletter. URL: https://zerocancer.org/newsletters/advanced-prostate-cancer/2024-2025
  8. Xiang, J., Dai, L., Tan, L., et al. (2025). Psychosocial experiences of prostate cancer survivors after treatment: a systematic review of qualitative studies. Frontiers in Public Health. URL: https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1625611/full
  9. Cornford, P., van den Bergh, R.C.N., Briers, E., et al. (2024). EAU-EANM-ESTRO-ESUR-ISUP-SIOG Guidelines on Prostate Cancer-2024 Update. Part I: Screening, Diagnosis, and Local Treatment with Curative Intent. European Urology, 86(2), 148-163.
  10. National Comprehensive Cancer Network. (2025). NCCN Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2.2025. URL: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
  11. Stop Blaming Water: THIS Is Why You're Waking Up at 2 AM - YouTube

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