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  "documentTitle": "PROCEPT BioRobotics Corporation (PRCT)",
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  "authorName": "Spruce Point Capital Management",
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  "sourceTypeLabel": "Short seller",
  "presentationDate": "2025-01-16 00:00:00",
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  "notes": "Uses expert testimony (urologist interviews) to undermine the company's market positioning.",
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      "kind": "callout",
      "text": "There is No “One-Size-Fits-All”",
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      "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.",
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      "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",
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      "kind": "source-note",
      "text": "Source: AUA Treatment Guidelines for BPH, Procept October 2024 investor presentation, Procept SEC filings, Spruce Point research",
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      "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.",
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      "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...”",
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      "kind": "title",
      "text": "Aquablation Is Not Right For “All Prostates” And Cannot Address Other Concomitant Issues",
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