{ "schemaVersion": "deck-intelligence.v1", "id": "019dd923-622c-750b-8b99-9ee2a1e788fb", "slug": "1233d0b05ad9", "title": "PROCEPT BioRobotics Corporation (PRCT)", "subtitle": "Spruce Point Capital Management · 2025-01", "author": "Spruce Point Capital Management", "date": "2025-01-16 00:00:00", "pageCount": 100, "kind": "activist-deck", "orientation": "landscape", "aspectRatio": 1.3333334, "targetCompany": "PROCEPT BioRobotics Corporation", "targetTicker": "PRCT", "document": { "id": "019dd923-622c-750b-8b99-9ee2a1e788fb", "slug": "1233d0b05ad9", "title": "PROCEPT BioRobotics Corporation (PRCT)", "rawTitle": "67890e6569b5d50b973b537d prct research thesis 1 16 2025", "authorId": "54_Spruce_Point_Capital", "authorName": "Spruce Point Capital Management", "authorDisplay": "Spruce Point Capital Management", "kind": { "slug": "activist-deck", "label": "Activist deck" }, "sourceType": { "slug": "short_seller", "label": "Short seller" }, "fileName": 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"pageNumber": 100, "frameworkName": "valuation-bridge" } ], "patterns": [] }, "storymakers": null, "score": null, "review": null, "activistThesis": { "tone": "adversarial", "notes": "Classic 100-page Spruce Point short report. Strong SCQA construction with multiple independent attack vectors: TAM overstatement (waterfall chart pg 11), CEO-quote contradictions vs urologist interviews (pg 12), channel-stuffing evidence via DSO/inventory/utilization puzzle pieces (pg 13), peer-multiple rerating (pg 97), and insider-selling tell (pg 14, 96). Cover is a striking AI-generated dental/medical office image — unusual for the genre. Inconsistency: slide 96 refers to 'CEO Radno' while all other slides use 'Zadno' — likely OCR or deck typo; treating correct name as Zadno. Author/signatory not named on cover; firm-authored. Spruce Point's founder is Ben Axler but not credited on the document itself. 'Precedents' are Spruce Point's own short track record (not activist analogies in the traditional sense), used on pg 4 as credibility flex.", "kpisCited": [ { "detail": "PRCT trades at 14.1x vs peer median 5.5x; only ISRG (21.3x) and GKOS (17.0x) trade higher", "metric": "EV / 2025E Revenue multiple" }, { "detail": "Rose from 47 (FY21) to 74 (FY22) to 130 (FY23), exceeding company's 30-90 day payment terms", "metric": "Days Sales Outstanding (DSO)" }, { "detail": "$27.2m in Q3 2024 implies 2.6 quarters of handpieces in inventory; DIOs up 33% from 164 in Q4 2023 to 218 in Q3 2024", "metric": "Finished goods inventory" }, { "detail": "Procept claims ~290,000; academic studies range 20,643-105,600 (median 67,207); Spruce Point top-down estimate 105,600", "metric": "US resective procedure volume" }, { "detail": "MISTs grew from 0 to ~40-45% of BPH surgeries since 2014", "metric": "MIST market share of BPH surgeries" }, { "detail": "Only ~4% of men over 70 have prostates over 100g (Berry et al, Journal of Urology)", "metric": "Large-prostate niche size" }, { "detail": "CEO Zadno sold ~$25m in October 2024 greenshoe, plus ~$10m in Nov/Dec via 10b5-1", "metric": "CEO insider sales" }, { "detail": "~$425,000 capital equipment; $3,200 per disposable handpiece", "metric": "HYDROS system ASP" }, { "detail": "Even with 100% high-volume and 50% low-volume hospital penetration and 75% resective share, totals just $1.9bn — less than half current EV", "metric": "10-year US revenue opportunity" }, { "detail": "Procept has penetrated 52% of high-volume BPH hospitals performing 71% of total procedures", "metric": "Hospital penetration" }, { "detail": "~$700,000 non-GAAP S&M spend to sell each ~$425,000 ASP system", "metric": "Sales & marketing cost per system" } ], "closingAsk": "Sell PRCT: Spruce Point rates Procept a Strong Sell with a $29-$54 price target implying 30%-60% long-term downside.", "extraction": { "at": "2026-04-22 21:58:34+00", "model": "unknown-legacy", "runId": null, "seconds": 160.98961, "promptVersion": null }, "scqaReward": "5x-9x 2025E revenue yields a $29-$54 target price range versus the ~$78 unaffected level — approximately 30%-60% long-term downside from current prices.", "thesisTypes": [ "fraud_exposure", "multiple_rerating", "management_change" ], "top3Reasons": [ "Aquablation serves only ~4% of BPH patients (large prostates), not the 'all prostates' TAM pitched", "DSOs ballooned 47 to 130 days; 2.6 quarters of handpiece inventory signals channel-stuffing", "CEO Zadno sold ~$25m of stock; Procept skipped Q4 pre-announcement first time in 4 years" ], "scqaSituation": "PROCEPT BioRobotics sells the Aquablation robotic resective surgery system for benign prostatic hyperplasia (BPH), with a $4.7bn market cap, pitching itself to investors as the future BPH 'treatment for all prostates'.", "thesisSummary": "PROCEPT BioRobotics markets its Aquablation system as the future 'treatment for all prostates' for the large BPH market, supporting a $4.7bn market cap and 14x 2025E revenue. Spruce Point's multi-month investigation — spanning urologist interviews, MAUDE adverse-event data, and academic procedure-volume studies — argues the real addressable market is dramatically smaller because minimally-invasive therapies (MISTs) already own 40-45% of BPH surgeries and Aquablation is best suited only for larger prostates (~4% of men over 70 have prostates over 100g). DSOs have ballooned from 47 to 130 days, finished-goods inventory equals 2.6 quarters of handpieces, and Procept failed to pre-announce Q4 results for the first time in four years while CEO Zadno dumped ~$25m of stock. Spruce Point rates PRCT a Strong Sell with a $29-$54 target, implying 30-60% downside.", "primaryDemands": [ "Short PRCT shares; Spruce Point assigns a Strong Sell opinion", "Investors should discount Procept's 'treatment for all prostates' TAM claim", "Scrutinize Procept's utilization KPI, DSOs, and handpiece inventory as signs of channel-stuffing", "Re-rate Procept to mature medical-device peer multiples (5x-9x 2025E revenue)" ], "scqaResolution": "Short the stock: Spruce Point rates PRCT a Strong Sell and expects the shares to rerate to mature medical-device peer multiples as growth disappoints and KPI credibility unwinds.", "thesisOneLiner": "Procept trades at 14x revenue on a false 'all-prostates' TAM; Spruce Point sees channel-stuffing via DSOs at 130 days, no procedure growth, and 30-60% downside to $29-$54.", "precedentsCited": [ "Spruce Point short on TSO3 (2017) — acquired by Stryker at 84% discount", "Spruce Point short on Stryker (2022) — 30% decline post-report", "Spruce Point short on HSKA (2021) — acquired by Mars at 48% discount", "Spruce Point short on Progyny (2023) — shares returned -54% in 2024" ], "scqaComplication": "Aquablation is only competitive for larger prostates (a tiny ~4% niche), MISTs already capture 40-45% of BPH surgeries, and rising DSOs (47 to 130 days) plus all-time-high inventory suggest channel-stuffing rather than real demand.", "narrativeInterest": 4, "notableSlidePages": [ 1, 11, 12, 13, 97, 100 ], "peerCompaniesCited": [ "Intuitive Surgical (ISRG)", "Glaukos (GKOS)", "LMAT", "Boston Scientific (BSX)", "PODD", "Penumbra (PEN)", "DexCom (DXCM)", "NARI", "RxSight (RXST)", "Establishment Labs (ESTA)", "Inspire Medical (INSP)", "iRhythm (IRTC)", "TransMedics (TMDX)", "MMSI", "ATRC", "TFX", "Tandem Diabetes (TNDM)", "ICUI", "STAAR Surgical (STAA)" ], "valuationFrameworks": [ "multiple_comparison", "sum_of_parts" ], "visualCraftInterest": 3 }, "pitchdeck": { "metadata": null, "profile": null }, "slides": [ { "page": 1, "type": "setup", "title": "The slide uses a clinical setting to frame the investment thesis as a 'medical' diagnosis of the company's claims.", "function": "front_matter", "imagePath": "https://imgproxy.kitesheet.com/ZlTg9y06K2DZ4Ai5fwtCCA1EJa4elu9bNXiQZkO705w/rs:fit:1200:1200:0/q:82/f:webp/czM6Ly9raXRlc2hlZXQvY29ycHVzL3NsaWRlcy8xMjMzZDBiMDVhZDkvcDAwMS5wbmc", "rawType": "cover", "block": null, "metadata": { "slideType": "cover", "slideTypeCanon": { "name": "Cover", "slug": "cover", "status": "active", "canonId": "019de52d-05f2-729d-9f93-e0504f0a2410", "version": 1, "description": null }, "function": "front_matter", "functionCanon": { "name": "Front matter", "slug": "front_matter", "status": "active", "canonId": "019de52d-133d-73f0-9e26-201eda96b098", "version": 1, "description": null }, "density": "sparse", "densityScore": 19, "componentCount": 5, "textChars": 307, "nDataPoints": 0, "notes": "The slide uses a clinical setting to frame the investment thesis as a 'medical' diagnosis of the company's claims.", "elementsJson": [ "photo", "callout_box" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:20.373+00", "seconds": 2.929, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/1", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-1", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Don't believe the hype; 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You should assume that as of the publication date of any presentation, report or letter, Spruce Point Capital Management LLC (\"SPCM\") (possibly along with or through our members, partners, affiliates, employees, and/or consultants) along with our subscribers and clients has a short position in all stocks (and are long/short combinations of puts and calls on the stock) covered herein, including without limitation PROCEPT BioRobotics Corporation (\"PRCT\") and therefore stand to realize significant gains in the event that the price declines.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.762+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "538a036e-875d-4922-8183-27e8a8550460", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.8, "x": 0.1, "y": 0.32 }, "kind": "disclaimer", "text": "This research presentation expresses our research opinions, which we have based upon interpretation of certain facts and observations, all of which are based upon publicly available information, and all of which are set out in this research presentation. Any investment involves substantial risks, including complete loss of capital. There can be no assurance that any statement, information, projection, estimate, or assumption made reference to directly or indirectly in this presentation will be realized or accurate.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.762+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "71675937-bfcf-4f4a-a0b1-87bf1f433ebf", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.8, "x": 0.1, "y": 0.75 }, "kind": "disclaimer", "text": "This report’s estimated fundamental value only represents a best efforts estimate of the potential fundamental valuation of a specific security... This is not an offer to sell or a solicitation of an offer to buy any security... All rights reserved. This document may not be reproduced or disseminated in whole or in part without the prior written consent of Spruce Point Capital Management LLC.", "attrs": null, "canon": { "kind": { "name": "Disclaimer", "slug": "disclaimer", "status": "active", "canonId": "91173477-d91f-4024-bbaf-d4f93e3f82dc", "version": 1, "description": "Legal/cautionary text that occupies most of the body of its slide." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.762+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d1f3c3fe-bab4-456e-8af4-30d930c382ac", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.8, "x": 0.1, "y": 0.48 }, "kind": "disclaimer", "text": "To the best of our ability and belief, as of the date hereof, all information contained herein is accurate and reliable and does not omit to state material facts necessary to make the statements herein not misleading... 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Procept trades at a $4.7 billion market cap and a 14x 2025E revenue multiple despite being an unprofitable, niche, highly disruptable, single-product company with structural growth barriers. Procept's valuation disconnect is particularly pronounced when compared to peers, which average just 5.5x revenue. We believe Procept is benefitting from its association with the \"robotic surgery\" and \"AI\" themes, even though both are questionable descriptors of the Company's business or capabilities. In fact, when we compare Procept to robotic surgery pioneer Intuitive Surgical (ISRG), the valuation north star for Procept bulls given its sector leading multiple, we find that any comparisons between the two are highly inappropriate. We also highlight that many of the bull case arguments of some sell-side analyst cheerleaders stand in direct conflict with Company statements and our research. In order to drive home the irrationality of Procept's valuation, we do an illustrative analysis of the Company's aggregate revenue and EBITDA opportunity over the next ten years. Despite making highly optimistic assumptions, such as 100% high volume and 50% low volume hospital penetration and 75% Aquablation share of resective procedures, we estimate that Procept's TOTAL 10-year revenue opportunity is just $1.9 billion, or less than half its current enterprise value. We believe Procept bulls must suspend all disbelief and be confident of perfect execution to come anywhere close to meeting Street estimates, which, as is, still call for declining revenue growth rates, the death knell for super-premium multiples. 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Street estimates call for over 500 bps of gross margin expansion over the next two years. However, we find that none of Procept's peers were able to achieve such levels of gross margin expansion when they grew from approximately $200 to $400 million of revenue. Additionally, we believe that Procept handpieces contain little differentiated or unique content and suspect that they are ripe for price compression over the coming years. Moreover, given the Company's history of frequent reclassifications and changing definitions, we have concerns about Procept's inventory, cost of goods sold, and thus gross margin accounting, particularly since the Company's lead audit partners have minimal to no experience with revenue-generating companies. We also lack confidence that Procept will be able to reduce the cost burden of its utilization reps, who will only become less efficient as the Company penetrates smaller, more geographically dispersed hospitals, and we note that the Company is still spending $700,000 in non-GAAP sales and marketing expense (excluding stock-based compensation) to sell each ~$425,000 ASP system. 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We believe too many handpieces at Procept and its hospital customers.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.023+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f42166ba-fd87-4446-8a2c-5a4e284bce36", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.96, "x": 0.02, "y": 0.94 }, "kind": "source-note", "text": "(1) While we assume no systems in finished goods inventory to simplify the analysis... 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"notes": "Uses a timeline-style visual to highlight the break in historical pattern.", "elementsJson": [ "headline_text", "callout_box", "timeline_visual", "screenshot", "paragraph" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:22.218+00", "seconds": 3.301, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/14", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-14", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.11, "w": 0.96, "x": 0.02, "y": 0.83 }, "kind": "callout", "text": "CEO Zadno sold 15% of his holdings as part of the greenshoe in the Company's October equity financing, yielding him almost $25 million before offering expenses. Procept management and directors were subject to a 60-day lock-up on further sales, yet 10b5-1 activity was carved out, which we believe, while not unheard of, violates the \"spirit\" of the lock-up. Zadno has taken advantage, selling another $10 million of shares in November and December.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:22.218+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "586a709c-72ae-4267-bdb8-c38f4636f2d7", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We highlight that, for the first time in four years and the first time as a public company, Procept failed to pre-announce Q4 results in early January.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:53+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d8-3fc727e2787b", "parentComponentId": null }, { "bbox": { "h": 0.45, "w": 0.96, "x": 0.02, "y": 0.32 }, "kind": "chart", "text": "Timeline of Q4 pre-announcements from 2022-2025", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": null, "framework": null }, "subkind": "timeline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:22.218+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "69b49395-5a08-45d4-a754-cee8e131fc46", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.96, "x": 0.02, "y": 0.27 }, "kind": "list", "text": "Procept Failed to Pre-Announce Q4 Results For the First Time in Four Years", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Timeline item", "slug": "timeline-item", "status": "active", "canonId": "019de52c-fd0e-74ce-9443-440fbd8c23b4", "version": 1, "description": null }, "framework": null }, "subkind": "timeline-item", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:22.218+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6416bb25-9769-4182-9c50-c4ec29f44e7b", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "We highlight that, for the first time in four years and the first time as a public company, Procept failed to pre-announce Q4 results in early January. We believe this is consistent with our thesis that its business has weakened materially. 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Thus, we believe Procept's vision of treating \"all prostates\" is highly questionable.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:21.871+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2f8fc4ac-7792-48b3-beab-b9f1b0abb6c8", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.5, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: AUA Treatment Guidelines for BPH, Urology Care Foundation BPH overview, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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or Aquablation): uses a high-pressure waterjet to destroy tissue. Slightly easier recovery than other resective procedures. Shorter procedure time, but much higher bleeding risk. Requires subsequent \"mini-TURP\" to cauterize tissue and control bleeding.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:53+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d8-57b4f5ef678b", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.96, "x": 0.02, "y": 0.33 }, "kind": "list", "text": "List of 8 BPH procedures with descriptions of their mechanisms, pros, and cons.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fd1ac263-933c-4594-aeb5-719d8ad98db2", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Practically all urologists learn the TURP procedure in medical school, and numerous population-based studies indicate it accounted for 45% - 50% of all BPH surgeries, and about 60% of resective procedures, over the past decade. However, there remains over a half dozen different resective (or other invasive) procedures that are still performed.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.704+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "888abef1-bbdb-4ce3-b5b7-aec67bcba19b", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.96, "x": 0.02, "y": 0.94 }, "kind": "source-note", "text": "Source: AUA Treatment Guidelines for BPH, Urology Care Foundation BPH overview, \"Minimizing Sexual Dysfunction in BPH Surgery\", Leong, et al, \"National Trends in Surgical Management for Benign Prostatic Hyperplasia From 2013 to 2019 in the United States\", Feiertag and Clark, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"headline_text", "paragraph", "bullet_list", "footnote" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:29.392+00", "seconds": 9.585, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/19", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-19", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.04, "w": 0.96, "x": 0.02, "y": 0.89 }, "kind": "callout", "text": "Insurance coverage: Resective procedures are generally only pursued when indicated (severe LUTS).", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "bcdc97ce-7ab1-4d37-9f66-8b3322ca2ca8", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "We believe Procept mischaracterizes the landscape for BPH procedures, both by suggesting that resective surgical procedures can displace drugs and MISTs and that Aquablation has the potential to be the \"one-size-fits-all\" treatment for all BPH sufferers.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:54+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d9-59095cf5b860", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.48, "x": 0.51, "y": 0.32 }, "kind": "list", "text": "Standard of care: Physicians will adhere to the accepted standard of care. Practice profile and procedure financial profile: Relative to salaried hospital staff, many private practice urologists are more sensitive to reimbursement rates and procedural efficiency. About half of practicing US urologists are in private practice, and those physicians strongly prefer MISTs since they get higher reimbursement, take less time, involve lower procedure risks and side-effects, and can be performed in-office. Expertise: Surgeons with highly specialized expertise, such as with HOLEP, often have a bias for that procedure, as well as a desire to retain their skills. Receptivity to new techniques: Over half of US urologists are over 55, and 29% are over 65. Moreover, many urologists hold strong opinions on the merits of different procedures based on their experience. Therefore, many urologists may not be open to learning new procedures. Generalizability: Physicians may prioritize/learn techniques applicable to a larger proportion of patients.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6ef87312-f570-49fd-8030-58cae626edc8", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.48, "x": 0.51, "y": 0.27 }, "kind": "list", "text": "Physician Factors", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b1ebd95e-c270-4441-a1f6-fb25748910b9", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.48, "x": 0.02, "y": 0.27 }, "kind": "list", "text": "Patient Factors", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c780ffc3-427b-494c-81e3-24bfc891db34", "parentComponentId": null }, { "bbox": { "h": 0.55, "w": 0.48, "x": 0.02, "y": 0.32 }, "kind": "list", "text": "LUTS: Patients with less severe symptoms are less likely to pursue treatment and incur the risks of side effects (irreversible for resective surgeries). Age: Since the average age of men undergoing surgical procedures for BPH is 71, procedure tolerability, morbidity risk, recovery time/ease, and anticipated lifespan are material considerations. Level of sexual activity and prioritization of sexual function: Some patients may be sexually inactive or not prioritize ejaculatory function. Other health conditions: Patients with high bleeding risk or taking blood thinning medications may seek/require procedures with lower bleeding risk. Prostate size: Certain procedures are either limited to smaller prostates or enable the treatment of larger prostates for various reasons. Affordability: MISTs can be more expensive than resective procedures. Retreatment considerations: Some patients, either due to age or personal preference, may willingly accept higher retreatment risk over a multi-year period.", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f92ce2ae-f26e-48fd-bb3e-2f69c8419615", "parentComponentId": null }, { "bbox": { "h": 0.09, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "We believe Procept mischaracterizes the landscape for BPH procedures, both by suggesting that resective surgical procedures can displace drugs and MISTs and that Aquablation has the potential to be the \"one-size-fits-all\" treatment for all BPH sufferers. There are valid medical and non-medical reasons why Aquablation may never even be the leading resective treatment.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c1e3e5df-1766-4a8e-83fa-e9591c1f9098", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.96, "x": 0.02, "y": 0.95 }, "kind": "source-note", "text": "Source: AUA Treatment Guidelines for BPH, Urology Care Foundation BPH overview, \"National Trends in Surgical Management for Benign Prostatic Hyperplasia From 2013 to 2019 in the United States\", Feiertag and Clark, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b1104add-ae58-40a1-a930-4cdab3688d35", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "Multiple Patient and Physician Issues Drive Treatment Selection; No \"One-Size-Fits-All\"", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.392+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e1be1c05-d0b3-4d56-b5b0-63fa7bd57f0f", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [ { "to": 20, "from": 11, "loop": { "name": "27_cost_of_inaction", "slug": "27-cost-of-inaction", "status": "active", "bestFor": "Urgent budget requests, compliance, risk mitigation", "canonId": "019dd956-70d1-7395-a15b-857ba858b394", "version": 1, "bodyDocId": "019df22a-2420-77be-bc41-ded96d08cb21", "structure": "The Status Quo -> The Hidden Costs Accumulating -> The Future State of Inaction -> The Tipping Point", "description": "Quantify what happens if the audience does nothing", "familyLabel": null }, "matchId": "7ffce90f-7469-4962-8ccc-f8b71e2baf08", "evidence": "Analysis of the BPH treatment market and the trade-offs of BPH treatments", "position": 0, "objective": "Highlighting the risks and limitations of Procept's Aquablation procedure", "confidence": 0.7, "extraction": { "at": "2026-07-16 22:00:46.797355+00", "model": "or:meta-llama/llama-4-scout", "runId": null, "seconds": null, "promptVersion": "doc-narrative-v1" } } ], "locked": true }, { "page": 20, "type": "evidence", "title": "The slide uses a table format to present qualitative evidence from expert interviews to support the thesis that MISTs are driven by physician incentives rather ", "function": "cite_precedent", "rawType": "testimonial", "block": null, "metadata": { "slideType": "testimonial", "slideTypeCanon": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52d-0a2d-7782-8a48-7e84df92cc97", "version": 1, "description": null }, "function": "cite_precedent", "functionCanon": { "name": "Cite precedent", "slug": "cite_precedent", "status": "active", "canonId": "019de52d-142b-714b-86d4-58aad7b568ec", "version": 1, "description": null }, "density": "balanced", "densityScore": 47, "componentCount": 6, "textChars": 991, "nDataPoints": 0, "notes": "The slide uses a table format to present qualitative evidence from expert interviews to support the thesis that MISTs are driven by physician incentives rather than just clinical superiority.", "elementsJson": [ "headline_text", "callout_box", "data_table" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:22.891+00", "seconds": 3.007, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/20", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-20", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "Private Practice Urologists Have Very Strong Financial and Other Incentives to Perform MISTs", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:53+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d8-a52ab81b5919", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "MISTs offer faster, out-patient procedures with no irreversible sexual side-effects and are financially superior for private practice urologists. While their durability has been debated (as we discuss more later), we find it hard to imagine that any patient will not choose a MIST unless they have a large prostate or are indicated for a resective procedure due to serious LUTS.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:22.891+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dce142ca-30ae-4f33-8012-447acb379141", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"although it pains me to say it, it's not about the patient, it's about the doctor and what pays the most. And the bottom line is for office-based procedures [such as MISTs] the doctor earns much more and they're pushed by Medicare and insurance because they cost less.\" — Spruce Point Interview with Major Hospital Urologist, Nov 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:53+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d8-ab6aeaa86e2e", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"confidence": null, "extraction": { "at": "2026-05-02 20:26:22.891+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "39a68956-4cf7-43b7-9012-38a09bd6345c", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "We Believe Investors Should Acknowledge The Strong Underlying Drivers Supporting MISTs", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:22.891+00", "model": 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"deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-21", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.22, "w": 0.47, "x": 0.51, "y": 0.34 }, "kind": "callout", "text": "In its IPO prospectus, Procept featured a lengthy discussion of its superior durability relative to MISTs despite a lack of long-term data. However, much of that language has been removed in its 2023 10-K. More recent data suggests that MIST durability is not materially worse than that of resective procedures. 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But the encouragement is that any third party analysts that is doing research with urologists, the feedback comes back consistently the product works. There's a sweet spot for this product in those smaller glands, and that's the majority of the market. So that's encouraging. But every research that's done that we've read all of them, the final sentence is, but I don't make as much money as I used to. 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We followed that up with a volume rebate this year. We put in a preauthorization for docs in the office side of service to make sure that they would get paid. We supported the product with clinical data to ensure that the retreatment rates would become a nonissue. And I haven't heard anything about retreatment. I'm sure in your checks, you probably haven't heard much either in the past. And we made changes to the management team...But the encouragement is that any third party analysts that is doing research with urologists, the feedback comes back consistently the product works. There's a sweet spot for this product in those smaller glands, and that's the majority of the market. So that's encouraging. But every research that's done that we've read all of them, the final sentence is, but I don't make as much money as I used to. 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One issue Procept hardly acknowledges is the significantly higher bleeding risk.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:24.381+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "fb01064d-12b6-47d8-951f-2c636b50aa60", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"the downside to Aquablation...is that it leaves a bloody mess inside the prostate when the water jets are done...There's no cautery or thermal effect, so there's no hemostasis. Every urologist has to go in there and basically open up a TURP set and transurethrally cauterize bleeders...You're adding costs.\" — Tegus Interview with Major Hospital Urologist, June 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:55+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d9-e5d89a672d1b", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.45, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: Procept initial draft filing of IPO prospectus, Tegus, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"callout", "text": "There is No “One-Size-Fits-All”", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.102+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "0929d3a4-b0a5-42bb-b095-a192b9d8d536", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Our research indicates that the comparative advantages of Aquablation are significantly reduced for patients with smaller prostates that still require a resective procedure. In addition, we highlight the practical reality that BPH patients are often found to suffer from other issues requiring surgery. Since Aquablation addresses a single indication, surgeons are forced to use traditional resective techniques when there are other issues that need to be addressed, thus reducing the addressable patient population.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.102+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "19d430da-e6b8-41aa-a518-131b92ba0959", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“I do think if the prostate is less than 40cc, Aquablation is annoying. It's a little too much, and I can just TURP that or UroLift that or Rezum that a little easier.” — Spruce Point Interview with Major Hospital Urologist, Nov 2024; “there's only so much Aquablation can do...I think its ceiling is going to be at about 50% of resective procedures...these clinical scenarios arise about half of the time in patients with severely large prostate, a bladder tumor, a bladder stone, a diverticula...For that reason, I think Aquablation at its peak will be essentially capped...” — Spruce Point Interview with Private Practice Urologist, Dec 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:55+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d9-b0665c548426", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.68, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: AUA Treatment Guidelines for BPH, Procept October 2024 investor presentation, Procept SEC filings, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. Numbered footnotes use attrs.numbered." }, "tool": null, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.102+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d186f0d4-143b-43cd-bd05-9ab17352b9ef", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.96, "x": 0.02, "y": 0.35 }, "kind": "table", "text": "Limitations on Prostate Size: As noted, certain resective procedures are more or less appropriate for larger or smaller prostate sizes. While Procept markets that it seeks to be the procedure of choice for “all prostates”, the reality is that (1) the AUA guidelines suggest Aquablation be limited to prostates between 30-80g, and (2) while Aquablation is likely able to resect a large prostate faster than a laser-based procedure, the size of the gland also presents commensurately greater bleeding risk. Unfortunately, none of the historical population-based BPH procedure studies include data on the size of the prostate treated. Procept has disclosed that about 73% of Aquablation procedures have been performed on prostates under 100g.", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.102+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "082bdd7b-48cf-463f-8726-000d6363f917", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.96, "x": 0.02, "y": 0.59 }, "kind": "table", "text": "Physician Perspectives on the Applicability of Aquablation: Spruce Point Interview with Major Hospital Urologist, Nov 2024: “I do think if the prostate is less than 40cc, Aquablation is annoying. It's a little too much, and I can just TURP that or UroLift that or Rezum that a little easier.” Spruce Point Interview with Private Practice Urologist, Dec 2024: “there's only so much Aquablation can do...I think its ceiling is going to be at about 50% of resective procedures, and I'll explain why. With BPH procedures, in addition to having a large prostate, we also have what we call concomitant pathology. What that means is there's something else going on in the bladder or the urethra or the prostate that necessitates further intervention, which Aquablation cannot address...these clinical scenarios arise about half of the time in patients with severely large prostate, a bladder tumor, a bladder stone, a diverticula...For that reason, I think Aquablation at its peak will be essentially capped...”", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.102+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "345d7221-fc60-49d7-a30a-82768753677e", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.65, "x": 0.305, "y": 0.02 }, "kind": "title", "text": "Aquablation Is Not Right For “All Prostates” And Cannot Address Other Concomitant Issues", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.102+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "03b7b675-ad55-4425-8174-782c7edfbb76", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [], "arcBeats": [], "loops": [], "locked": true }, { "page": 32, "type": "tension", "title": "Uses a combination of regulatory guidelines and expert testimony to undermine the product's long-term value proposition.", "function": "expose_contradiction", "rawType": "expose_contradiction", "block": null, "metadata": { "slideType": "expose_contradiction", "slideTypeCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-124c-75aa-984a-0a3d0d8fc8df", "version": 1, "description": null }, "function": "expose_contradiction", "functionCanon": { "name": "Expose contradiction", "slug": "expose_contradiction", "status": "active", "canonId": "019de52d-171f-776f-887c-73edaff4cf9c", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 82, "componentCount": 9, "textChars": 2693, "nDataPoints": 0, "notes": "Uses a combination of regulatory guidelines and expert testimony to undermine the product's long-term value proposition.", "elementsJson": [ "headline_text", "callout_box", "paragraph", "screenshot", "quote_block" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:25.288+00", "seconds": 3.961, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/32", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-32", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.08, "w": 0.24, "x": 0.02, "y": 0.32 }, "kind": "callout", "text": "The Science Remains Unsettled", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8655fb8b-6d29-4584-ae63-2e91d44c807e", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Despite its uptake, the long-term science around Aquablation remains unsettled. Thus, the procedure receives only a conditional recommendation and a lower evidence level grade versus TURP by the AUA.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:55+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4d9-ff807d0478a4", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Despite its uptake, the long-term science around Aquablation remains unsettled. Thus, the procedure receives only a conditional recommendation and a lower evidence level grade versus TURP by the AUA. Given the hype cycle related to BPH treatments, we find some urologists were simply more comfortable waiting for more information on long-term efficacy.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4e48550f-79f1-4a9e-ab25-6d8ab6f5e0c6", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.71, "x": 0.27, "y": 0.32 }, "kind": "paragraph", "text": "While we acknowledge that Aquablation is approved by the FDA and presented as a viable treatment option by the AUA, the longer term impacts and durability have not been extensively studied. For this reason, the AUA BPH Treatment Guidelines still give Aquablation a “Conditional Recommendation; Evidence Level: Grade C”. This compares unfavorably to TURP, which has received a “Moderate Recommendation; Evidence Level: Grade B”.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d6461a9d-2119-48d6-a6af-03445aa4feb4", "parentComponentId": null }, { "bbox": { "h": 0.18, "w": 0.73, "x": 0.25, "y": 0.75 }, "kind": "quote", "text": "there are different frameworks for looking at the same issue. Objectively, it's true that it's a shorter procedure with presumably lower incontinence rates and ejaculatory dysfunction. But I think that there will remain other procedural options there for a lot of men. And I think that another big thing to consider with Aquablation is that the long-term data is just not out there yet. And so we don't know 10-year data on recurrence rates of prostate regrowth...I just feel hesitancy because, in the history of the BPH marketplace, so many procedures come out every five or ten years and most of them don't stick.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.288+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9abcd7fe-ecdf-47c1-97f0-e42aa4bbce08", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "there are different frameworks for looking at the same issue. Objectively, it's true that it's a shorter procedure with presumably lower incontinence rates and ejaculatory dysfunction. But I think that there will remain other procedural options there for a lot of men. And I think that another big thing to consider with Aquablation is that the long-term data is just not out there yet. And so we don't know 10-year data on recurrence rates of prostate regrowth...I just feel hesitancy because, in the history of the BPH marketplace, so many procedures come out every five or ten years and most of them don't stick. — Spruce Point Interview with Community Hospital Urologist, Nov 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:55+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4da-03bb8a0da9ad", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.65, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: AUA Treatment Guidelines for BPH, Procept October 2024 investor presentation, Procept SEC filings, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/33", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-33", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.05, "w": 0.61, "x": 0.37, "y": 0.54 }, "kind": "callout", "text": "Procept highlights the “high” value as opposed to the materially lower risk implied by the low end of the range.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.183+00", "model": 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While we do not dispute either advantage, we do believe Procept mischaracterizes the issue.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.183+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1aced5c7-8170-4609-a2fa-8836e492d21c", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.96, "x": 0.02, "y": 0.62 }, "kind": "paragraph", "text": "Importantly, Procept only highlights the risks relative to other resective procedures. We note that the same study found zero risk of ejaculatory dysfunction with MISTs.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.183+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "733efe02-a622-4954-914a-bd52b210da34", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“It must be appreciated however that pre-operative ejaculatory dysfunction is common in men undergoing TURP being estimated around 30–35%.” — DeLay, et al. “...I spent so much time counseling these men that ejaculation is stupid, it's not orgasm...I say your wife doesn't want that slop anywhere near her...if you're not sexually active, who cares what we do.” — Major Hospital Urologist, Nov 2024. “Most of these patients are either already on Flomax, which itself can cause retrograde ejaculation, or are beyond their childbearing years...the average 70-year-old is not going to care about [ejaculatory dysfunction] as long as they still have good libido and good erections.” — Community Hospital Urologist, Nov 2024.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:57+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4da-d13995b35898", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.9, "x": 0.02, "y": 0.95 }, "kind": "source-note", "text": "Source: Procept October 2024 investor presentation, Minimizing Sexual Dysfunction in BPH Surgery, Leong, et al, “Ejaculatory dysfunction in the treatment of lower urinary tract symptoms”, DeLay, et al, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/34", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-34", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.12, "w": 0.39, "x": 0.59, "y": 0.77 }, "kind": "callout", "text": "We highlight this point, as it contradicts Procept's well-worn pitch that Aquablation achieves results irrespective of surgeon skill.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 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However, trends can be examined. In our series, we identified several interesting findings. Aquablation and WVTT had a higher proportion of reports representing clinically significant complications. The rates of reports of clinically significant complications did not change over the 4 year reporting period. Additionally, the clinically significant complications were not associated with device related malfunctions. Therefore, similar to findings associated with urolift, we suspect that the adverse events could be associated with surgical experience.24 While several other studies have evaluated the MAUDE database with BPH, this cohort is the first to include all transurethral options.25,26", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.153+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "6675bf5f-33d9-48b6-b625-c0e060e3979f", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Heidenberg, et al, examined the FDA's Manufacturer and User Facility Device Experience (MAUDE) database of medical device reports submitted by mandatory reporters and found that the incidence of \"significant\" complications for Aquablation was materially higher than for other BPH procedures. We believe this stands in stark contrast to Procept's marketing of Aquablation as a quick and easy procedure that can be performed on any type of patient.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:25.153+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ac97f58a-e1be-4633-bedd-837922099176", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.8, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: \"Are adverse events during surgery for benign prostatic hyperplasia device related? 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Also, current CMS guidelines still place limitations on treating patients with “known or suspected” prostate cancer.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:30.842+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "55407eba-b3e8-450f-8cd2-03cdcba91e86", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I think that's a valid critique. 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And that really depends on the physician and how good they are as well. — Spruce Point Interview with Former Procept Executive, Nov 2024; with the previous generation, it heavily relied on Procept people in the room who were pretty much there handholding, guiding and training them. And it did take, I don't remember the exact number, what it used to take, but it took at least three months. So, three months of very scheduled handholding…we identified as an issue that many novice surgeons struggled with…thinking about a prostate in 2D [from the ultrasound image] but the cutting wasn't 2D right? …it's a 3D organ…and then that potentially led to risk of cutting too deep in areas that they were not supposed to…maybe you've spoken to somebody who was very experienced and for them it's easy, but we clearly saw this as an area where many struggled… — Spruce Point Interview with Former Procept Manager, Nov 2024; …right now, I would say 90% of all physicians need a representative of the company to be there present for the cases…you'll probably have physicians that have done 50 cases and still not independent…a lot of these new physicians that are coming out don't have the TURP skills, the semi rigid skills…So first and foremost, I do think there is a bigger learning curve for newer physicians, younger physicians than older physicians. — Spruce Point Interview with Former Procept Sales Rep, Nov 2024; I'm in my fifties. 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Based on our conversations with urologists that have used both the AquaBeam and HYDROS, the mechanical improvements of the new system include a more surgeon-friendly configuration, improved ultrasound imaging, and a touchscreen.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.354+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7047b44b-7ef3-4323-87f2-102e4784440e", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "We get it; surgical robots are exciting, and evoking comparison to robotic surgery leader Intuitive Surgical might just confer some of that company's rich valuation multiples. That doesn't change the fact that referring to the AquaBeam system as \"robotic\" is a stretch.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:26.354+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ac8ec9ac-0d1a-4997-9c7a-5520441fbda7", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"So, the robotic portion of it is very small...the robot will cut the tissue based off of the surgeon's plan.\" — Former Procept Executive; \"The first generation that was launched years ago, I would say it was pretty clunky. It's like with any product introduction, you roll with what is clinically viable.\" — Former Procept Manager; \"So I kind of giggle when I get to tell my patients this is a robotic procedure. It's really just an automated procedure, but it's faster.\" — Major Hospital Urologist; \"...at the best that you would call it a robotic-assisted procedure. Robotic alludes to being automated. This was not. It was actually very intensive and part of the complication of the business model of PROCEPT and one of the reasons why I left, which was that there's nothing robotic about it. Essentially, the rep, meaning me, is in there basically doing the procedure for the surgeon. 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Using the original AquaBeam, surgeons would indicate the tissue targeted for removal by drawing the resection limits on the ultrasound image. Our research indicates this pre-treatment planning phase is relatively easy. HYDROS seeks to streamline pre-treatment planning by using historical procedure data to suggest the resection limits. Some sell-side analysts have latched onto this capability assuming (1) it offers dramatic value to the surgeon and (2) promises such material procedure time savings that it will enable the performance of additional Aquablations in a given day, thus enhancing system ROI for hospitals. We don't believe either is true, at least materially.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.708+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7f4dc1fa-56d9-49e1-bbaf-b636d76ea692", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"I'd say, because you have a rep in the room, [pre-planning] can take a minute or so, but [with the AI] you're talking about shaving off a minute here or a minute there, not 15 minutes.\" — Former Procept Executive, Nov 2024; \"to me, the AI is a pain in the ass because you can't rely on it; you have to check it... 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I think it's meaningless...the old system, which I have to say in 27 years it's the best version 1.0 of anything I've ever seen. But I got the TV screen on my left, the ultrasound on my right, and my head's turning left to right. I'm not going to say I get sore, but the HYDROS has everything right in front of me. The old system which I use is not a touch screen, so I kind of have to lean across my body and press buttons through a giant shower cap over the keyboard. It's a little bit of a pain in the ass, but I'm used to it. It's like, why do we upgrade our iPhones every year? You can say it's a little better, but it's really the same crap. 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We believe this creates a more tenuous competitive position than typically seen in the market for innovative medical devices/systems.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d9e50882-1572-46c0-8945-4e68a6b26b2d", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.96, "x": 0.02, "y": 0.3 }, "kind": "paragraph", "text": "Pulling Back the Curtain: Procept Doesn't Own Its Key IP", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1b72ab8a-fcbe-4753-8ef7-4104a484898a", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.96, "x": 0.02, "y": 0.58 }, "kind": "paragraph", "text": "License Agreement with HydroCision... [Legal text detailing license terms]", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7becc7f8-e342-446e-ba90-c50c922b98ee", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.96, "x": 0.02, "y": 0.35 }, "kind": "paragraph", "text": "License Agreement with AquaBeam... [Legal text detailing license terms]", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "865a37e3-d65a-41b3-b151-086103d879c4", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.96, "x": 0.02, "y": 0.77 }, "kind": "paragraph", "text": "We heavily depend on intellectual property licensed from third parties and our licensors may not always act in our best interest. If we fail to comply with our obligations under our intellectual property licenses, if the licenses are terminated, or if disputes regarding these licenses arise, we could lose significant rights that are important to our business.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "da99363e-f94c-42d4-b835-759f70eef7ac", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "We heavily depend on intellectual property licensed from third parties and our licensors may not always act in our best interest. If we fail to comply with our obligations under our intellectual property licenses, if the licenses are terminated, or if disputes regarding these licenses arise, we could lose significant rights that are important to our business. — Procept 2023 10-K", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:56+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4da-8f536716e768", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.35, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Red underline for Spruce Point emphasis. Source: Procept 2023 10-K", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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null, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "423dc48f-a5ea-4cd7-8c40-945a4398b519", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "e71137f1-3e1d-4a07-a991-028fd4c4b8cb", "evidence": "Highlights reliance on third-party IP as a hidden risk to business model sustainability.", "framework": null, "confidence": 0.85, "extraction": { "at": "2026-05-02 20:26:27.538+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 45, "frameworkName": "fraud-exposure" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 46, "type": "tension", "title": "Uses a grid layout to present four distinct supplier profiles as evidence of operational risk.", "function": "name_villain", "rawType": "villain_critique", "block": null, "metadata": { "slideType": "villain_critique", "slideTypeCanon": { "name": "Villain critique", "slug": "villain_critique", "status": "active", "canonId": "019de52d-10bc-7136-bf20-09de59d17447", "version": 1, "description": null }, "function": "name_villain", "functionCanon": { "name": "Name villain", "slug": "name_villain", "status": "active", "canonId": "019de52d-1746-70d6-bc58-5eeaf5865526", "version": 1, "description": null }, "density": "overcrowded", "densityScore": 79, "componentCount": 9, "textChars": 1159, "nDataPoints": 4, "notes": "Uses a grid layout to present four distinct supplier profiles as evidence of operational risk.", "elementsJson": [ "headline_text", "paragraph", "callout_box", "photo", "screenshot" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:27.402+00", "seconds": 3.245, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/46", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-46", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": { "h": 0.08, "w": 0.48, "x": 0.51, "y": 0.86 }, "kind": "callout", "text": "Very small private German company founded in 2014 with 2022 assets of $2 million per filed financials and <20 employees per LinkedIn.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.402+00", "model": 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}, "componentId": "5c1fbbeb-3d6e-4e45-9744-7ac5c1f6560e", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.48, "x": 0.02, "y": 0.54 }, "kind": "callout", "text": "Small state-sponsored Chinese company that reported $10 million of revenue in FQ2 2022. Terminated announced IPO in December 2022. Tariff / trade risks?", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.402+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7c01159b-e04b-4e19-abec-00dbdc4efd44", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.48, "x": 0.51, "y": 0.54 }, "kind": "callout", "text": "Very small family-run contract manufacturer with 19 employees per S&P Capital IQ.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.402+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c320e78c-ca99-4a1e-83a0-a11ce4e28899", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Procept discloses the existence of four key suppliers in its SEC filings. We are troubled by what we found regarding each of these companies.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:56+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee35-7258-b4da-a1e0a3d74bba", "parentComponentId": null }, { "bbox": { "h": 0.62, "w": 0.96, "x": 0.02, "y": 0.27 }, "kind": "image", "text": "Supplier imagery (Shantou, Myriad, HydroCision, MTT)", "attrs": null, "canon": { "kind": { "name": "Image", "slug": "image", "status": "active", "canonId": "019de52c-f978-701f-a720-51d029d769e7", "version": 1, "description": "Photo, illustration, screenshot or icon." }, "tool": null, "subkind": { "name": "Photo", "slug": "photo", "status": "active", "canonId": "019de52c-fd37-757f-b4a8-ca26d4888875", "version": 1, "description": null }, "framework": null }, "subkind": "photo", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.402+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "449651c9-2016-4db6-bfb7-ab53c6b80073", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Procept discloses the existence of four key suppliers in its SEC filings. We are troubled by what we found regarding each of these companies. Given Procept's history of recalls and persistent adverse events related to equipment malfunction, we believe investors should more closely scrutinize the Company's supplier risks.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:27.402+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "d407308e-e2cc-4ba9-bf82-99c1d239602c", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.7, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: Procept 2023 10-K, SIUI website, Myriad Fiber website, Google Maps, HydroCision website, LinkedIn, German financial filings", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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14, "componentCount": 4, "textChars": 291, "nDataPoints": 0, "notes": "Spruce Point Capital Management branding (pine tree logo).", "elementsJson": [ "headline_text" ], "confidence": 1, "extraction": { "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "at": "2026-05-02 20:26:27.022+00", "seconds": 2.398, "promptVersion": "v2-canon-conditioned" } }, "links": { "slide": "/slides/019dd923-622c-750b-8b99-9ee2a1e788fb/47", "deck": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb", "deckAnchor": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb#slide-47", "deckJson": "/decks/019dd923-622c-750b-8b99-9ee2a1e788fb.json" }, "components": [ { "bbox": null, "kind": "callout", "text": "We Believe Procept Dramatically Overstates Its True Addressable Market", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual 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Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. (Clinical Principle) 27. Clinicians should not perform surgery solely for the presence of an asymptomatic bladder diverticulum; however, evaluation for the presence of bladder outlet obstruction (BOO) should be considered. (Clinical Principle)", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:28.747+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "3236bd83-69e7-4561-95c1-c24a722c2382", "parentComponentId": null }, { "bbox": { "h": 0.25, "w": 0.55, "x": 0.22, "y": 0.65 }, "kind": "list", "text": "More Invasive Surgery: In severe cases of BPH or when other options fail, more invasive surgery is recommended. Surgery is best if you: Are unable to pass urine, Have kidney damage, Have frequent urinary tract infections, Have a lot of bleeding, Have stones in the bladder", "attrs": null, "canon": { "kind": { "name": "List", "slug": "list", "status": "active", "canonId": "019de52c-f94b-779b-a53b-fd4904a5f4d2", "version": 1, "description": "Bullet or numbered list." }, "tool": null, "subkind": { "name": "Bullet list", "slug": "bullet", "status": "active", "canonId": "019de52c-fc98-7169-a083-5cab805076ca", "version": 1, "description": null }, "framework": null }, "subkind": "bullet", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:28.747+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "8355a1f6-84ef-437b-97b2-6194b0f0e6ea", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "Resective surgical procedures will undoubtedly remain an important part of BPH treatment for those suffering from LUTS seriously impacting quality of life. However, we believe Procept's pitch that all patients will, or even should, progress immediately to a resective procedure goes against AUA guidelines and the reality of the current catalysts for any level of surgical intervention.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:28.747+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "148efe6a-903c-47f8-8552-2ecf40f1989e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "Surgery is recommended for patients who have renal insufficiency secondary to BPH, refractory urinary retention secondary to BPH, recurrent urinary tract infections (UTIs), recurrent bladder stones or gross hematuria due to BPH, and/or with LUTS/BPH refractory to or unwilling to use other therapies. — Clinical Principle (AUA Treatment Guidelines)", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:59+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929a-02e38e35d173", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.45, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Red underline for Spruce Point emphasis. Source: AUA Treatment Guidelines for BPH, Urology Care Foundation BPH overview", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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the small number of BPH patients that ultimately pursue a resective procedure due to the standard of care and insurance coverage considerations.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:32.413+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c88a1988-3952-4a24-9052-32256ad2eb02", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I have very, very strong opinions about that. So we generally do a guideline based approach...there are very clear guidelines for when you operate...The very small group that doesn't start with pills are what we call an absolute indication for surgery: those who show up with a catheter because they can't pee...that's about 5% of our surgeries. — Spruce Point Interview with Major Hospital Urologist, Nov 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:59+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929a-93231064fbce", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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0.42 }, "kind": "callout", "text": "As we discussed earlier, just 4% of men over 70 have prostates above 100g, and our research found that Aquablation is most competitive versus MISTs and other resective procedures for larger prostates, above 80-100g. 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Based on our research, we believe the diagnosis code for BPH is misapplied when ordering PSA tests so that the 12 million patients referenced by Procept is an overestimation. The NIDDK notes that, consistently over the past decade, just 2% of BPH patients each year pursue any form of surgical intervention (MIST or resective). Based on disclosed UroLift volumes from Teleflex and our estimate of current Rezum volumes, we believe just 55% of total interventions are resective surgeries. 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It's just a function of how a lot of PSA tests are ordered; people just use that code for that. So there's probably a significant overestimation of total disease burden.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:34.72+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cc4644e7-5a50-41b3-b1fc-17671d78951b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“...if you're looking at diagnosis codes, so guys that have the N40.1 or the subcodes beneath that who have a diagnosis of symptomatic BPH...that's a really misleading number, because that code will get dropped in all kinds of situations that really may not mean this guy has symptomatic BPH. 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"kind": "paragraph", "text": "As highlighted on the previous page, we estimate Procept has already penetrated over 50% of high volume hospitals in the US. As a result, bullish sell-side analysts have started assuming that Procept will sustain its growth by (1) selling multiple systems into those high volume facilities, and/or (2) achieve widespread penetration of low volume hospitals once they focus their sales effort on those less attractive customers. However, our research finds significant skepticism among former Procept sales reps and current Aquablation users regarding both of those assumptions.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.718+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "794c075e-274a-4468-8d63-46731b01b6a6", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I mean, in even the highest volume accounts, no more than two. No more than two. — Former Procept Executive, Nov 2024; My guess is never, and here's why...I know the numbers...[there are] dedicated cystoscopy suites in most hospitals. They're only used 30% of the time because another surgeon can't use the room...So the room is available 70% of the time. And at academic hospitals and Kaisers, there's usually one or two BPH folks. So that's all we have. And we're not looking to hire more because all the money's made with prostate cancer and kidney cancer. I'm the BPH guy and they don't want another one. So I don't see any reason to have two... — Major Hospital Urologist, Nov 2024; those low volume [hospitals], they're just hard. They really are. — Former Procept Sales Rep, Nov 2024; from a hospital standpoint, convincing a hospital to buy a machine for one indication and just one indication for one specialty is sort of silly... especially in these community hospitals...we have eight different specialists in our hospital using the da Vinci robot five days a week. For Aquablation you need to have buy-in from at least a few urologists from your group. If you just have one urologist using it, then he's using it maybe one day a week maximum. — Community Hospital Urologist, Nov 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:58+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-9299-b0053b5d5590", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.15, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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For example, the AUA 2023 Census found that 48% of urologists do four or fewer major procedures per month. We believe this finding greatly limits the potential adoption of an expensive, single-indication system like the AquaBeam. 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Given potential distortions related to either newly purchased system ramp up or the number of “accounts” versus systems, we present an alternative metric using quarterly handpiece unit sales divided by previous quarter systems installed base divided by three. Either way, the answer is the same: flat utilization.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:30.388+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b2c60bf9-f2c4-43c5-ad24-d6ffc7b7e5a9", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.7, "x": 0.25, "y": 0.78 }, "kind": "quote", "text": "We're shrinking fast, and there's not enough urologists. So nobody can grow their volume for anything because we all have a three month wait to get to see me and a two month wait or three month wait for surgery. That's my only negative on this whole market. Nobody's going to grow it because the bottleneck is the number of urologists...you might see my BPH volume going up 1% per year just because of demographics, but I can't see more patients. Bottom line is I can see 25 patients a day and do eight surgeries a week, and I can't do more.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:30.388+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "500595d0-4ab8-475b-8fea-31f10e8d6a18", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"We're shrinking fast, and there's not enough urologists. So nobody can grow their volume for anything because we all have a three month wait to get to see me and a two month wait or three month wait for surgery. So that's my only negative on this whole market. Nobody's going to grow it because the bottleneck is the number of urologists...you might see my BPH volume going up 1% per year just because of demographics, but I can't see more patients. Bottom line is I can see 25 patients a day and do eight surgeries a week, and I can't do more.\" — Spruce Point Interview with Major Hospital Urologist, Nov 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:49:59+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929a-1c2be1e6af23", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.4, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Procept SEC filings, Procept earnings call transcripts, AUA 2023 Census", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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We believe this may slow Aquablation procedure growth.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:29.243+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "c4e3e552-c03f-4f92-98dd-d4d09441fe0b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“...there have been a lot more changes into the Medicare and kind of guidelines and an increase in Medicare audits for Aquablation, as well as commercial insurance audits, because strictly Aquablations are indicated for certain sizes of the prostate, but this past year some more restrictive guidelines were released, including size criteria, objective urinary flow assessment criteria, objective questionnaire criteria to allow for approval of Aquablation. 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Based on Rhodes, et al, prostates grow about 1.6% per year...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:35.063+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "20de299c-17a0-4cf9-897c-291daa29a47a", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.31, "x": 0.67, "y": 0.58 }, "kind": "quote", "text": "\"...we were all brought up [to view] resective procedures [as a] last resort...it's not enough to have a really great product if you have to actually change the way surgeons think about managing this disease...\"", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:35.063+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "46e430b7-b879-4c3d-82cc-a904550d2fdc", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"...we were all brought up [to view] resective procedures [as a] last resort...it's not enough to have a really great product if you have to actually change the way surgeons think about managing this disease, which is really challenging...guys have to be treated earlier...the most powerful indicator [of success] is less severe symptoms going in...the earlier you're intervening, the more [patients] tend to skew towards less invasive procedures...\" — Spruce Point Interview with Private Practice Urologist, Dec 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:00+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929a-cdce5b7e180c", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.96, "x": 0.02, "y": 0.94 }, "kind": "source-note", "text": "Red box for Spruce Point emphasis. Source: \"Longitudinal Prostate Growth Rates During 5 Years In Randomly Selected Community Men 40 To 79 Years Old\", Rhodes, et al, The Journal of Urology, \"Urologic Diseases in America, Annual Data Report, Benign Prostatic Hyperplasia and Associated Lower Urinary Tract Symptoms\", April 26, 2024, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Procept will struggle in the younger guys, smaller prostates. I'd say somewhere between 10%, maybe, maybe 15% [of my patients] are in that very large category... realistically, they're rare. ...what's not being communicated there is that all of the value of Procept is in bigger prostates.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:31.2+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5e5fbe53-1b1a-4a5a-937e-ad625400e17b", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "But as you skew younger, you're going to have guys that are more interested in less invasive procedures. 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There's temporary incontinence, but we can overcome that...So, what if somebody invents a robotic HoLEP? There is at this point a cocktail napkin design of [it]. So it's many, many years away. But that would replace ablation in five minutes because laser is better than waterjet. The waterjet is sloppy. It's imprecise. It doesn't go deep enough, but it's the best we have. 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Robotic-assisted HoLEP (RoLEP™) represents the first clinical application of its platform. HoLEP was initially developed in 1998 by Prof. Peter Gilling and Mr. Mark Fraundorfer in New Zealand. The procedure has rapidly gained recognition as the gold-standard treatment for benign prostatic hyperplasia (BPH or enlarged prostate), though a steep learning curve has limited its adoption. 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One is robotic HoLEP. So there's no question HoLEP is the best because you remove more tissue and it's bloodless. There's temporary incontinence, but we can overcome that...So, what if somebody invents a robotic HoLEP? There is at this point a cocktail napkin design of [it]. So it's many, many years away. But that would replace ablation in five minutes because laser is better than waterjet. The waterjet is sloppy. It's imprecise. It doesn't go deep enough, but it's the best we have. Laser is just better.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:31.836+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e5c27191-42a0-42aa-966d-28f88eb2a484", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“So there are two threats [to Aquablation]. One is robotic HoLEP. So there's no question HoLEP is the best because you remove more tissue and it's bloodless. 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However, most prostate cancer occurs on the peel or rind, the outside of the prostate. As a result, we believe a waterjet is simply a less effective tool for addressing that part of the prostate. 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Those platforms that they're going to be competing with were originally designed for prostate cancer and are now moving on to the additional BPH. Those therapies were done for prostate cancer and now will get coding to bill for BPH during the procedure. You can do two procedures where you make essentially 1.5X one of those procedures.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.23+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9d677ebf-6856-4b75-a32a-af3d8da6879a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "I think it's tricky with their technology...prostate cancer grows in the peripheral zones of the prostate...I'd worry about rupturing the prostate or even worse, potentially injuring structures right outside of the prostate and adjacent to the prostate, specifically the rectum...I think from a logical perspective, it does not make sense to use Aquablation for prostate cancer or focal therapy for prostate cancer. — Tegus Interview with Private Practice Urologist, Dec 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:01+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929b-8bc7ffae1f7c", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.48, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: Tegus, EDAP press release, Profound Medical press release, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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The number of men diagnosed with intermediate-risk prostate cancer opting for AS/WW more than doubled in 10 years, increasing from 5.0% in 2010 to 12.3% in 2020, showing a shift towards more conservative management.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:32.775+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5d183c05-1e59-47ce-8470-a70f1c2ff068", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "According to the American Cancer Society, surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate. However, recent research from the Yale School of Medicine found a “substantial increase” in the adoption of active surveillance and watchful waiting treatment strategies over the past decade. 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There have been major changes over the past decade with much more use of initial monitoring for cancers determined to be ‘low risk.’”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:32.775+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "dfe24edc-ab07-4b4a-98de-5e04ac56ecd9", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.74, "x": 0.24, "y": 0.84 }, "kind": "quote", "text": "“I have a hard time kind of understanding exactly where they're going to position themselves in the world of prostate cancer.”", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:32.775+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "73e66fe3-da94-40c4-9d9c-e8f05805845a", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"One of the challenges in managing localized prostate cancer is determining the risk posed to an individual patient,\" said the study's senior author Dr. Michael Leapman, the clinical program leader of the prostate and urologic cancers program at Yale Cancer Center and an associate professor of urology at Yale School of Medicine. \"We know that many prostate cancers will not spread or cause symptoms if untreated. 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In addition, based on our conversations with both urologists and former Procept sales reps, we believe it is common practice for hospitals to stock (and thus order) at most a month or two of handpiece units, which makes the rising DSO trend difficult to explain, as it would seem to suggest a significant change in the size of hospital handpiece orders.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:41.315+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b7546e52-e9d6-4101-9335-ca7c641aeab7", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.73, "x": 0.25, "y": 0.64 }, "kind": "quote", "text": "my schedule is so set that we now have, I think, seven or eight on the shelf, and they just replace them pretty much every 10 days.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:41.315+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "2b3ae59e-a7e8-443c-8a33-eb13ee09962d", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.73, "x": 0.25, "y": 0.73 }, "kind": "quote", "text": "...hospitals purchase [handpieces] upfront, and they do keep some inventory. 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However, we note that Procept disclosed a material weakness in its internal controls at IPO, and the Company's auditors consider systems revenue recognition a critical audit matter.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.61+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "5acdd65a-f638-4cbe-9393-ddbb80cd4d5c", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.32 }, "kind": "paragraph", "text": "In connection with the preparation of our consolidated financial statements, a material weakness in our internal control over financial reporting was identified as of December 31, 2020...", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.61+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cf690a16-0420-4687-be61-5acb5c1b516c", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.9, "x": 0.05, "y": 0.86 }, "kind": "quote", "text": "The Company has granted rebates on a limited basis, and those rebates have been historically immaterial.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.61+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "e17b1ebc-bfce-4b97-b454-62de5016d802", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "“The Company has granted rebates on a limited basis, and those rebates have been historically immaterial.” — Procept 2023 10-K", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:08+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-92a0-2ac7e39576d3", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.3, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Procept 424b, Procept 2023 10-K", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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Also, DIOs have risen 33% from 164 in Q4 2023 to 218 in Q3 2024. (1)", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4010583d-edd4-42d0-8264-ffb05e25f4e9", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.22, "x": 0.02, "y": 0.74 }, "kind": "callout", "text": "DSOs now exceed the high end of Company 30 to 90 day payment terms.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "a21264dc-bde4-47e3-b538-a5695e300692", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Procept and Its Hospital Customers Are Stuffed With Excess Handpieces", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:02+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929b-e7d6713bf9cf", "parentComponentId": null }, { "bbox": { "h": 0.22, "w": 0.22, "x": 0.02, "y": 0.47 }, "kind": "chart", "text": "Rising DSOs chart", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Vertical bar chart", "slug": "bar-vertical", "status": "active", "canonId": "019de52c-fe9d-70f2-b3b7-a9ae294f5917", "version": 1, "description": null }, "framework": null }, "subkind": "bar-vertical", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "45637a12-342e-46ca-9c2e-d5a30d0d7949", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "DSOs: 130", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:02+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929b-eb244fa55490", "parentComponentId": null }, { "bbox": { "h": 0.08, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "What do you get when you combine rising DSOs (potentially resulting from sales incentives), all-time high finished goods inventory (we believe likely comprised largely of handpieces), flat system utilization (ie, flat handpiece consumption), and a smaller than estimated procedure volume market? We believe too many handpieces at Procept and its hospital customers.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:33.179+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7000cb7f-2af3-4317-ad1c-424b9f88da88", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.96, "x": 0.02, "y": 0.93 }, "kind": "source-note", "text": "(1) While we assume no systems in finished goods inventory to simplify the analysis... Source: Procept SEC filings, previously footnoted academic research and government data sources, Spruce Point research", "attrs": { "numbered": true }, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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"text": "Procept’s “utilization” definition is handpieces “purchased”, not handpieces “used”. If handpieces “purchased” overstates known US procedures (as the Company’s proxy disclosure suggests), and if rising DSOs are indicative of hospitals ordering more handpieces than they need, then not only is Procept’s “utilization” metric overstated, it might even be meaningless.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.326+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "35198818-ffc1-45da-8c53-d4aa91e506c2", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "US Handpiece Sales Overstatement: 12%", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:03+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929c-918999be281a", "parentComponentId": null }, { "bbox": { "h": 0.35, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "As discussed, we believe it is natural for anyone analyzing Procept’s business to assume that US handpiece unit sales are a good proxy for US Aquablation procedures. In fact, the Company conflates handpiece unit sales with procedures in its presentations.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.326+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "f612b8f2-4902-4e05-8e15-c11f97bd0852", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.45, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: Procept SEC filings, Procept Q3 2023 earnings call transcript, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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US Handpiece Sales Overstatement of Actual Procedures (H=G/F-1) 12%", "attrs": null, "canon": { "kind": { "name": "Table", "slug": "table", "status": "active", "canonId": "019de52c-f9c8-7148-8119-eaac9594cd28", "version": 1, "description": "Tabular data layout." }, "tool": null, "subkind": { "name": "Data table", "slug": "data", "status": "active", "canonId": "019de52d-02d5-75b8-8abf-88e92bf63569", "version": 1, "description": null }, "framework": null }, "subkind": "data", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.326+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "b90b8b29-a656-4ad3-b015-f6f539378c86", "parentComponentId": null }, { "bbox": { "h": 0.12, "w": 0.65, "x": 0.31, "y": 0.03 }, "kind": "title", "text": "Are Handpiece Unit Sales Really An Accurate Proxy For US Aquablation Procedures? Is “Utilization”, As Calculated, Meaningless?", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.326+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "ed4dcb39-5822-46f4-8293-9c5ac55668b9", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "a0a70629-b363-4a87-9bb5-d1fa69d6468c", "evidence": "The slide explicitly attempts to expose a discrepancy between reported metrics and actual operational reality to suggest misleading 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Revenue Recognition Disclosure Related to Rental Activity (Last Appeared in 2022 10-K)", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:34.33+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1c41ed01-545e-491c-967d-7f79ea8824da", "parentComponentId": null }, { "bbox": { "h": 0.04, "w": 0.9, "x": 0.05, "y": 0.41 }, "kind": "callout", "text": "Procept's Disclosed Rental and Evaluation Unit Commentary and Disclosures Suggest Modest Activity", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:34.33+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "954db644-3f8d-4599-84a5-65868f197b0e", "parentComponentId": null }, { "bbox": null, "kind": "callout", "text": "Given how often this issue arose in our research, we believe Procept may not be fully disclosing its rental activities, perhaps because such arrangements may be indicative of difficulties closing system sales.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": { "name": "Visual emphasis", "slug": "visual-emphasis", "status": "active", "bestFor": null, "canonId": "019dd9e1-474b-736b-a8eb-a794dd88241c", "version": 1, "bodyDocId": null, "description": "Drawing the eye to one element above the rest of the slide.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64d2-7657-bbdb-cfee52a42491", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Implied US Rental Revenue", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64d2-7657-bbdb-d562c2a959cf", "parentComponentId": null }, { "bbox": { "h": 0.15, "w": 0.9, "x": 0.05, "y": 0.15 }, "kind": "paragraph", "text": "On its Q1 2022 earnings call, Procept disclosed that it had placed ten evaluation units with customers as of YE 2021, and the following quarter, CFO Waters downplayed the Company's system rental activity.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:34.33+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "7f8e7b55-e948-4a67-b6b1-beb9c012cc48", "parentComponentId": null }, { "bbox": { "h": 0.05, "w": 0.7, "x": 0.25, "y": 0.46 }, "kind": "quote", "text": "And we may periodically put a rental out with a customer, but right now, our model is pretty much we're going to sell and not offer a demo program.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Pull quote", "slug": "pull-quote", "status": "active", "canonId": "019de52c-fbf9-76fe-97e1-a0b7540445c9", "version": 1, "description": null }, "framework": null }, "subkind": "pull-quote", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:34.33+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "60cdcfca-1692-4446-8657-c2473ef7e38b", "parentComponentId": null }, { "bbox": { "h": 0.06, "w": 0.9, "x": 0.05, "y": 0.83 }, "kind": "quote", "text": "Systems rented for a fixed monthly fee during an evaluation period... are recognized as revenue straight-line during the lease term, and are not material.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": 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1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-23 01:18:10+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd953-64d2-7657-bbdb-d1ccc8007d2d", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.5, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "Source: Procept Q1 2022 earnings call transcript, Procept Q2 2022 earnings call transcript, Procept SEC filings", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": 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Former sales reps we spoke with were unable to explain this disclosure.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:37.877+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "93a5dab0-5990-461d-ba32-8f0deda6ca69", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"it is possible that some of our activities, such as stock-option compensation paid to physicians or our practice of loaning equipment to customers at no additional cost, could be subject to challenge under one or more of such laws.\" — Procept 2023 10-K", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:03+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929c-7ad1ed3238d0", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.3, "x": 0.01, "y": 0.97 }, "kind": "source-note", "text": "Source: Procept 2023 10-K, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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I mean, all hospitals are trying to cut costs right now. It's interesting because hospitals right now don't even look at reimbursement... 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The other part is molded plastic with a tiny chip on it, so it's probably double-digit dollars to make. So, the margin is infinite. It's a huge margin.", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": null, "subkind": { "name": "Testimonial", "slug": "testimonial", "status": "active", "canonId": "019de52c-fc21-71b6-9ac3-8266a64945e8", "version": 1, "description": null }, "framework": null }, "subkind": "testimonial", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:41.343+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "eb3e33a9-5c3e-4f53-b25f-a2de9768f42e", "parentComponentId": null }, { "bbox": null, "kind": "quote", "text": "\"It's about the size of your arm from your elbow to your fingers. Half of it is just a metal stick with the scope part. The other part is molded plastic with a tiny chip on it, so it's probably double-digit dollars to make. So, the margin is infinite. It's a huge margin.\" — Major Hospital Urologist, Nov 2024", "attrs": null, "canon": { "kind": { "name": "Quote", "slug": "quote", "status": "active", "canonId": "019de52c-f8fb-751e-8bc6-d58e2d59562a", "version": 1, "description": "Pull quote or testimonial." }, "tool": { "name": "Authority citation", "slug": "authority-citation", "status": "active", "bestFor": null, "canonId": "019dd9e1-49ae-7557-89ad-3fca70469b45", "version": 1, "bodyDocId": null, "description": "Quoting an authority figure, study, or precedent to lend weight.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": null, "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:03+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929c-2222f1fb79ef", "parentComponentId": null }, { "bbox": { "h": 0.02, "w": 0.45, "x": 0.02, "y": 0.97 }, "kind": "source-note", "text": "Source: S&P Capital IQ, Procept October 2024 investor presentation, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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While not uncommon in the medical device sector, we believe the high cost burden (maybe $1,000/day fully loaded) compares unfavorably to the approximate $2,000 gross profit earned per handpiece ($3,200 x ~60% gross margin). 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While some market participants may reference robotic surgery pioneer and market leader Intuitive Surgical (ISRG) to support Procept’s multiple, we believe a comparison of the two companies makes any such rationalization misguided.", "attrs": null, "canon": { "kind": { "name": "Callout", "slug": "callout", "status": "active", "canonId": "019de52c-f8d3-761a-8953-7d37080de5e2", "version": 1, "description": "Highlighted callout box." }, "tool": null, "subkind": { "name": "Primary callout", "slug": "primary", "status": "active", "canonId": "019de52c-fbd1-70eb-a9ce-8997f8674c1d", "version": 1, "description": null }, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.368+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "866cc0dc-2f8f-4c22-acc3-91a29b1aa5e4", "parentComponentId": null }, { "bbox": { "h": 0.2, "w": 0.8, "x": 0.1, "y": 0.35 }, "kind": "chart", "text": "Enterprise Value / 2025E Revenue", "attrs": null, "canon": { "kind": { "name": "Chart", "slug": "chart", "status": "active", "canonId": "019de52c-f9a0-76ef-adc6-0b859109d1f8", "version": 1, "description": "Quantitative chart." }, "tool": null, "subkind": { "name": "Vertical bar chart", "slug": "bar-vertical", "status": "active", "canonId": "019de52c-fe9d-70f2-b3b7-a9ae294f5917", "version": 1, "description": null }, "framework": null }, "subkind": "bar-vertical", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.368+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "1f6bbc16-d8a0-457b-b068-3caf1ed342b9", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "Enterprise Value / 2025E Revenue: 14.1x", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:05+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929d-b92cc077dd96", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.6, "x": 0.05, "y": 0.95 }, "kind": "source-note", "text": "(1) Based on estimated total handpieces sold. 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"extraction": { "at": "2026-05-02 20:26:36.368+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "03244178-bf49-4e73-9392-f82ccf1ad756", "parentComponentId": null }, { "bbox": { "h": 0.1, "w": 0.8, "x": 0.05, "y": 0.05 }, "kind": "title", "text": "Procept Trades At A Massive, Unjustifiable Premium To Its Peers", "attrs": null, "canon": { "kind": { "name": "Title", "slug": "title", "status": "active", "canonId": "019de52c-f7dd-76d9-b848-b1f12bd85cf4", "version": 1, "description": "Slide title or headline." }, "tool": null, "subkind": { "name": "Headline", "slug": "headline", "status": "active", "canonId": "019de52c-fae1-7463-9a7c-d60668eced0d", "version": 1, "description": null }, "framework": null }, "subkind": "headline", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:36.368+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "4d0586fb-acb2-4480-91e5-1f171364d63e", "parentComponentId": null } ], "metrics": [], "tools": [], "frameworks": [ { "matchId": "0cfbd208-3c5a-463b-98a5-254003d10688", "evidence": "Direct comparison of valuation multiples and operational metrics between target and peer.", "framework": null, "confidence": 0.9, "extraction": { "at": "2026-05-02 20:26:36.368+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "pageNumber": 97, "frameworkName": "comparison-frame" } ], "arcBeats": [], "loops": [], "locked": true }, { "page": 98, "type": "resolution", "title": "The slide uses a 'generous' set of assumptions to preemptively counter potential bull-case arguments regarding market penetration.", "function": "size_opportunity", "rawType": "valuation_table", "block": null, "metadata": { "slideType": "valuation_table", "slideTypeCanon": { "name": "Valuation table", "slug": "valuation_table", 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"confidence": null, "extraction": { "at": "2026-04-22 22:50:04+00", "model": "unknown-legacy", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "019dd952-ee36-760b-929d-60ec7d52f8d8", "parentComponentId": null }, { "bbox": null, "kind": "metric", "text": "10-year revenue opportunity: $1,864", "attrs": null, "canon": { "kind": { "name": "Metric", "slug": "metric", "status": "active", "canonId": "019de52c-f923-73bf-8081-d0b1a8c5264d", "version": 1, "description": "Big-number or KPI value." }, "tool": { "name": "Quantification", "slug": "quantification", "status": "active", "bestFor": null, "canonId": "019dd9e1-47ab-72ce-a079-aab1f5299e88", "version": 1, "bodyDocId": null, "description": "Translating a claim into numbers, charts, or tables.", "familyLabel": null }, "subkind": null, "framework": null }, "subkind": "primary", "groupRole": null, "confidence": null, "extraction": { "at": "2026-04-22 22:50:04+00", "model": "unknown-legacy", "runId": null, "seconds": 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To stand any chance at justifying the current valuation, one must assume the stars align and Procept not only becomes, but also remains, a more dominant BPH treatment than the market has ever seen ten years from now and that the Company is able to expand beyond its BPH niche, the prospects for which look grim given our view of technology fit and the timelines to commercial ramp for medical equipment.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:37.341+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "9c7680ae-c778-4c2c-a898-3a41b21976f0", "parentComponentId": null }, { "bbox": { "h": 0.11, "w": 0.96, "x": 0.02, "y": 0.17 }, "kind": "paragraph", "text": "We believe Procept will fail to meet revenue growth, and thus profitability expectations and faces long-term existential threats. As a result, we would expect the stock to trade in-line with mature medical device/equipment peers in the future. Even assuming Street forecasts are correct, a comparable company 5-9x 2025E revenue multiple range yields a target price range of $29 to $54 per share, implying approximately 30% to 60% downside.", "attrs": null, "canon": { "kind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "5f2affc0-941d-4d07-959d-4bfc1930cea4", "version": 1, "description": "Single prose block in the body of a slide." }, "tool": null, "subkind": { "name": "Paragraph", "slug": "paragraph", "status": "active", "canonId": "019de52c-fb80-75af-aa5c-a7a4bfac2433", "version": 1, "description": null }, "framework": null }, "subkind": "paragraph", "groupRole": null, "confidence": null, "extraction": { "at": "2026-05-02 20:26:37.341+00", "model": "google/gemini-3.1-flash-lite-preview-20260303", "runId": null, "seconds": null, "promptVersion": null }, "componentId": "cb4a6e92-571f-4294-a154-dc3dd548b62b", "parentComponentId": null }, { "bbox": { "h": 0.03, "w": 0.25, "x": 0.02, "y": 0.96 }, "kind": "source-note", "text": "Source: S&P Capital IQ, Spruce Point research", "attrs": null, "canon": { "kind": { "name": "Source note", "slug": "source-note", "status": "active", "canonId": "23484952-494b-4a5e-b1ad-550d0d70e948", "version": 1, "description": "Attribution / source / caveat placed at the slide footer. 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