Benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is the growth of glandular and stromal tissue in the transition zone of the prostate. The American Urological Association (AUA) calls BPH largely a diagnosis made under the microscope; what brings men to treatment are lower urinary tract symptoms (LUTS), which can also come from the bladder, the urethra or other causes. Zhang and colleagues, reviewing the acupuncture trials, cite estimates that BPH affects about a quarter of men in their 50s, a third in their 60s and half in their 80s. The trials score symptoms on the International Prostate Symptom Score (IPSS), a 35-point questionnaire on which, as Chen and colleagues set out, 8 to 19 is moderate and 20 or more severe. They also measure the maximum urine flow rate (Qmax) and the urine left in the bladder after voiding (post-void residual). All but one of the trials in Zhang’s review used electroacupuncture, in which a small current runs between inserted needles.

No Cochrane review covers acupuncture for BPH. Zhang’s 2017 review pooled the three trials that compared acupuncture with a sham procedure and found symptom scores lower with acupuncture after 4 to 6 weeks by less than the 3 points the AUA’s 2010 guideline took as the smallest change patients notice, and no difference at 12 to 18 weeks. A 2024 review of electroacupuncture, mostly against drugs, reported larger differences in trials it judged heterogeneous. NICE advises against offering acupuncture for male LUTS; the 2026 European guideline does not mention it. An 11-hospital sham-controlled trial registered in 2022 has published its protocol and no results.

Is there a Cochrane review of acupuncture for BPH?

No. A search of Europe PMC’s index of the Cochrane Database of Systematic Reviews, which carries protocols as well as reviews, found neither a review nor a protocol on acupuncture for BPH or male LUTS. Cochrane has reviewed non-drug treatments for chronic prostatitis and acupuncture for overactive bladder; Chronic prostatitis and Overactive bladder and nocturia report those reviews.

Systematic reviews

Zhang’s team, at Guang’anmen Hospital in Beijing with a co-author from the Mayo Clinic, judged every trial at high risk of bias for blinding of participants, except two in which men lay prone for needling at the sacrum, which limited their ability to tell real from sham treatment. The sham controls were needling at non-acupoints in two trials and shallow needling at a non-acupoint in the third. Restricted to the two trials judged higher in quality, the short-term difference was 3.01 points (95% CI −5.19 to −0.84), which the authors call borderline for a noticeable change. Five of the eight trials needled the sacral points BL33 (Zhongliao) and BL35 (Huiyang), three of them with needles longer than 75 mm. The reviewers left out trials that used Chinese patent medicines as the control, on the grounds that their effect on urinary symptoms is unproven. Every trial recruited Chinese men, and seven of the eight followed them for three months or less. The authors conclude that it is not certain acupuncture can produce clinically significant changes.

Chen’s review included only trials scoring 4 or more on the modified Jadad quality scale. One of its six drug comparisons is a 2008 multicentre trial of 276 men whose control was Qianliekang tablets, a Chinese patent medicine of the kind Zhang excluded. Its one sham-controlled trial had 42 men. Both pooled IPSS results varied between trials more than chance allows (I² of 72% and 86%). The abstract prints the IPSS figures again for flow rate; the full text gives Qmax 2.51 mL/s higher than with drugs (95% CI 1.71 to 3.31). The authors list as limitations that every study came from China, the heterogeneity, the small samples and the absence of long-term follow-up.

Guo and colleagues, at Heilongjiang University of Chinese Medicine, screened Chinese and English databases and ranked the points the 85 studies used. The most frequent were CV04 (Guanyuan), CV03 (Zhongji), SP06 (Sanyinjiao), CV06 (Qihai), BL23 (Shenshu), ST28 (Shuidao), BL28 (Pangguangshu), SP09 (Yinlingquan), CV02 (Qugu) and BL32 (Ciliao). The authors call for rigorous trials to test these selections.

Trials

Against sham or non-acupoint needling

• Deep sacral electroacupuncture, 2013. At Guang’anmen Hospital, Wang and colleagues randomised 100 men with an IPSS of 8 or more to electroacupuncture at both BL33 points, with 100 mm needles inserted 6 to 8 cm through the third sacral foramen, or the same stimulation at two non-acupoints 2 cun to the side, 16 sessions over four weeks. In the intention-to-treat analysis IPSS fell from 20.10 to 12.84 with BL33 and from 18.76 to 16.42 with the non-acupoints, a 4.51-point greater fall at week 6 and 3.2 points at week 18. Flow rate and post-void residual did not differ. The authors note that the control was still needling, so the trial cannot rule out effects of needling itself or of placebo, and that it ran in one hospital.
• Low-frequency electroacupuncture against sham, 2011. Yu and colleagues randomised 42 men with LUTS to 2 Hz electroacupuncture for 20 minutes twice a week, twelve sessions, or sham electroacupuncture. Voided volume and average and maximum flow rose more with electroacupuncture; IPSS and prostate-specific antigen (PSA) did not differ, and the authors judged the clinical improvement quite limited.
• Distinct meridian points, 2003. In a pilot published in the Journal of Urology, Johnstone and colleagues randomised 30 men whose prostate biopsy had found no cancer to observation, nine sessions over three months at points of the kidney-bladder distinct meridian, or nine sessions at points not expected to affect the prostate. Neither IPSS (p = 0.063) nor PSA changed significantly, and the authors concluded that the treatment neither relieved LUTS nor affected PSA.

Against drugs or another acupuncture method

• Zhongji against a patent medicine, 2008. In a single-blind multicentre trial in Chinese, Liu and colleagues gave 276 men electroacupuncture at CV03 or Qianliekang tablets. The share each group graded as improved was 96.4% with electroacupuncture and 86.2% with the tablets.
• Needling depth, 2019. Yuan and colleagues randomised 120 men to electroacupuncture at BL32 and BL33 with deep or shallow insertion, three times a week for four weeks. IPSS and quality of life improved more with deep insertion; flow rate and post-void residual did not differ.
• Sacral points against abdominal points, 2025. In a Chinese-language trial, Zhou and colleagues randomised 58 men with mild to moderate symptoms to electroacupuncture at points beside the sacrococcygeal joint and BL35, or at CV04, CV03, CV02, ST28, SP06 and ST36 (Zusanli), for four weeks. IPSS fell more with the sacral points, and the share graded as improved was 75.0% against 39.3%; prostate volume did not change in either group.
• Added to alpha-blockers, 2022. In a Korean pilot with blinded assessors, Kim and colleagues randomised 28 men already taking an alpha-blocker to six weeks of electroacupuncture with electronic moxibustion or the drug alone. IPSS fell more in the combined group at weeks 3, 6 and 12; flow rates, prostate volume and quality of life did not differ. There was no sham group.

Trials without published results

A team led from Guang’anmen Hospital, where Wang’s trial ran, published a 2024 protocol for a two-arm trial that plans to randomise 306 men aged 40 to 80 with moderate to severe LUTS, across 11 Chinese hospitals, to 24 sessions of electroacupuncture or sham electroacupuncture over eight weeks, with participants and assessors blinded and follow-up to week 24. Its primary outcome is the share of men whose IPSS falls by at least 30% at weeks 8 and 20. Its registry entry was last updated in July 2024, gives its status as unknown with recruitment the last known state, and estimated primary completion for September 2025. A Europe PMC search by its registration number found only the protocol when this page was checked.

Harms

Six of the eight trials in Zhang’s review reported adverse events and none was serious: two men had an urge to defecate after acupuncture that passed within three days, one had depression and fatigue later diagnosed as male menopausal syndrome, and two had a mild haematoma after sham needling. Chen’s review counted seven men who fainted during electroacupuncture, three with bruises under 3 cm on the lower abdomen and two who felt pain during needling, and found no difference in adverse events between electroacupuncture and control groups.

What the guidelines say

NICE’s guideline on lower urinary tract symptoms in men (CG97), published in May 2010, tells clinicians not to offer homeopathy, phytotherapy or acupuncture for LUTS in men. That recommendation dates from 2010 and its evidence has not been reviewed since; the guideline was last updated in June 2015, on drug treatment. NICE’s guideline page records that it checked the evidence in August 2024 and plans an update.

The European Association of Urology’s 2026 guideline on non-neurogenic male LUTS, summarised in European Urology in April 2026 with a literature search from May 2023 to May 2025, does not mention acupuncture anywhere in its full text.

The AUA’s 2026 guideline, published in three parts in the Journal of Urology in May 2026 on searches to January 2025 updated in December 2025, follows a 2023 amendment of its previous edition, whose changes concerned drug combinations and procedures. The abstract of Part II, on medical management, says it covers behavioural and lifestyle interventions alongside drugs. Neither that abstract nor the public guideline page mentions acupuncture; the full text, behind an AUA login, was not read for this page. Clinical guidelines sets these positions beside other bodies’.

What the reviews could not settle

The one pooled comparison with sham rests on three trials of 190 Chinese men, found a short-term difference below the threshold Zhang used for a change patients notice, and found none by 12 to 18 weeks. Two of its three sham controls were full-depth needling at other sites, and Wang’s authors note that such a control cannot rule out the effect of needling itself. The larger differences in Chen’s review come mostly from comparisons with drugs, one of them a patent medicine, in trials that mostly did not describe blinding; five of its trials also reported an effective rate, the share of men graded as improved, where Zhang kept to continuous scores. Most trials followed men for three months or less, and Zhang notes that BPH progresses over years and calls for trials that record acute urinary retention and surgery. The 11-hospital sham-controlled trial is the one designed to follow men to 24 weeks with blinded participants; Urinary retention covers the separate research on men who cannot void.

AcuiQ’s benign prostatic hyperplasia, lower urinary tract symptoms and nocturia pages list the protocols individual studies prescribed, each with its citation.