Acupuncture-Related Interventions for Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

Chronic prostatitis (CP) is a common condition for which pharmacological therapies often provide unsatisfactory outcomes. Acupuncture has emerged as a promising supportive therapy. However, further comparative studies are needed to clarify the relative effectiveness of different acupuncture modalities versus standard pharmacological therapies, particularly because most existing trials used active rather than sham-controlled comparisons.

METHODS

This network meta-analysis (PROSPERO: CRD420251180258) evaluated acupuncture-related therapies for CP. Randomized controlled trials (RCTs) published through October 2025 were identified. The primary outcome was the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). Analyses were conducted using Stata 17.0, with mean differences (MDs), 95% confidence intervals (CIs), and SUCRA rankings calculated. Most included studies compared acupuncture-related therapies with pharmacological treatments rather than sham controls.

RESULTS

Forty-five RCTs involving 3534 participants were included. Acupuncture-related therapies, alone or combined with medication, were associated with greater improvements in NIH-CPSI outcomes than conventional medications in active-controlled trials. Warm needle acupuncture (WMA) ranked highest for total NIH-CPSI improvement (SUCRA 94.1%) and response rate (RR = 1.35, 95% CI 1.20-1.51; SUCRA 91.4%). Electroacupuncture (EA) demonstrated favorable effects across multiple outcomes, ranking second for total NIH-CPSI improvement (SUCRA 86.2%) and showing benefits in pain relief and quality of life. EA combined with Western medicine ranked highest for pain relief, while auricular acupoint therapy showed advantages for urinary symptoms. Manual acupuncture combined with Chinese herbal medicine ranked highest for quality-of-life improvement.

CONCLUSION

Acupuncture-related therapies may serve as useful complementary approaches for improving CP symptoms in active-controlled trials. WMA showed the greatest overall improvement and response rates, whereas EA and EA combined with Western medicine demonstrated benefits across multiple symptom domains. However, these findings should be interpreted cautiously because most studies were conducted in Chinese populations, evidence certainty was predominantly low to moderate, and long-term follow-up data were limited.