Inspired by Liou et al 2025.[1]
EA – electroacupuncture
MA – manual acupuncture
IF – impact factor
MSKCC – Memorial Sloan Kettering Cancer Center
ADT – androgen deprivation therapy
IPSS – international prostate symptom score
MCID – minimal clinically important difference– key to acronyms
This week we are sticking with the urinary system, and I have chosen to highlight a research letter just out in JAMA Oncology (IF 22.3).
The team from MSKCC have focussed on the symptom of nocturia in men who had been treated previously for prostate cancer. Whilst the effect of acupuncture on nocturia has been recognised for more than 3 decades in the west,[2] this is the first trial to specifically target men following treatment for prostate cancer.
This is described as a pilot study (n=60), but it is also a feasibility study. The design was pragmatic with a waiting list only control and a 2:1 random allocation to the active intervention. The men recruited had to have no evidence of disease following treatment for prostate cancer and had to have a baseline severity of 2 or more episodes of nocturia per night for the prior month. Randomisation was stratified based on previous treatment with androgen deprivation therapy (ADT), since this known to increase nocturia and other co-morbid symptoms. Just over a third of subjects fell into this category.
Acupuncture treatment included both MA and EA and was performed weekly for 10 weeks. Points were used on the back, lower limbs, and ears. The main points used were BL23, BL28, BL31, BL33, BL35, BL40, KI3, KI7, SP6, Kidney (ear point), and Bladder (ear point). Additional points were allowed to treat comorbid symptoms. EA was performed from BL23 to BL33 or BL52 for 20 to 30 minutes at 2 to 10 Hz.
The primary outcome was the nocturia item on the IPSS, which is scored from 0 to 5. The IPSS includes 7 items each scoring from 0 to 5, and one further item assessing quality of life that is scored from 0 to 6. The IPSS total score is calculated from the first 7 items, and there are subscales for storage and voiding. The total IPSS score is 35 and the MCID is considered to be 3.
Outcomes were measured at baseline, week 4, week 10 (end of treatment), and week 14 (1 month follow-up). The baseline score for nocturia was 3 (ie the subjects were getting up 3 times at night on average) and this was reduced by just over 1 at 10 weeks in the acupuncture group. It was unchanged in the waiting list group. Over the same time period the total IPSS score fell by just over 3 in the acupuncture group and stayed at the baseline level (~13) in the waiting list group. The differences between groups were highly significant at both week 10 and week 14.
Scores related to storage (including nocturia) appeared to change more than those related to voiding. This seems to fit with both our experience as well as anatomical and neurophysiological logic.
This large group from MSKCC (the author list runs to 15) have done well with this pilot, making it big enough to demonstrate both a statistically significant as well as a clinically relevant change in the active treatment group. We are likely to see other publications with the secondary outcome measures since there was not much space made available in this research letter in JAMA Oncology, and presumably the team will try to secure funding for a larger scale trial.
References
1 Liou KT, Carlsson S, Ajay D, et al. Acupuncture for Nocturia in Survivors of Prostate Cancer: The NOCTURNAL Randomized Clinical Trial. JAMA Oncol. Published Online First: 29 May 2025. doi: 10.1001/jamaoncol.2025.1199
2 Kelleher C, Filshie J, Burton G, et al. Acupuncture and the treatment of irritative bladder symptoms. Acupunct Med. 1994;12:9–12. doi: 10.1136/aim.12.1.9
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