Redefining Prostate Cancer Care: How PROCEPT BioRobotics' Aquablation Therapy Could Disrupt Urology and Unlock a $10B+ Market

In the evolving landscape of urologic oncology, a quiet revolution is underway. PROCEPT BioRobotics (NASDAQ: PRCP), a pioneer in robotic-assisted waterjet surgery, has achieved a milestone that could redefine how localized prostate cancer is treated: three successful outpatient procedures using Aquablation therapy in an Ambulatory Surgery Center (ASC). This breakthrough, part of the WATER IV Prostate Cancer Trial, signals the dawn of a new era where minimally invasive, cost-effective care for prostate cancer may no longer be confined to hospital operating rooms.

The Disruption: From Hospital to ASC, and from BPH to Oncology

Aquablation therapy, initially developed for benign prostatic hyperplasia (BPH), has already demonstrated superior safety and efficacy compared to traditional transurethral resection of the prostate (TURP). Now, the technology is being tested as a first-line treatment for localized prostate cancer. The WATER IV Trial, a U.S. FDA-approved randomized study, compares Aquablation with radical prostatectomy in men with Grade Group 1–3 tumors. Early results from the trial—three complication-free procedures in an ASC—highlight the potential to shift care from high-cost hospital settings to outpatient facilities, reducing healthcare expenditures by up to 40% and enabling faster recovery times.

This shift is not merely logistical. The ability to treat prostate cancer in an ASC setting challenges the status quo of urology practice models. Radical prostatectomy, while effective, is associated with significant morbidity, including erectile dysfunction and urinary incontinence. Aquablation's robotic precision, guided by real-time ultrasound and AI-driven planning, aims to preserve critical anatomical functions while resecting diagnosed cancer. If the trial confirms non-inferior oncologic outcomes and superior functional preservation, the therapy could become a preferred option for millions of men annually.

Market Expansion: A $10B+ Opportunity in Oncology

PROCEPT's long-term vision has always been clear: to expand beyond BPH into the broader urology market. The WATER IV Trial represents a critical step in that journey. While the BPH market is estimated at $2.5B, the global prostate cancer treatment market exceeds $10B, with rising incidence rates and a growing demand for less invasive options. If Aquablation gains regulatory approval for oncology, PROCEPT could capture a significant share of this market, particularly as reimbursement dynamics align.

The company's recent regulatory wins—most notably the new Category I CPT code for Aquablation (effective January 1, 2026)—underscore its commercial potential. This code, coupled with a Medicare reimbursement rate of $540 (slightly higher than TURP), provides a strong financial incentive for adoption. With the HYDROS Robotic System now in full market release, the company is poised to scale installations and consumables sales in tandem with clinical validation.

Risk Mitigation and Clinical Confidence

Critics may question the scalability of Aquablation in oncology, but the trial's design addresses these concerns. With a 3:1 randomization ratio favoring Aquablation and a 10-year follow-up period, the study is structured to generate robust data on both safety and long-term oncologic outcomes. The primary endpoints—urinary incontinence and erectile dysfunction rates at 6 months—focus on patient-reported outcomes that matter most to urologists and payers.

Moreover, the company's financial resilience is a key strength. In Q4 2024, PROCEPT reported 57% revenue growth, with U.S. system revenue up 67% to $27.6M and handpiece/consumables revenue up 36% to $29.3M. While a temporary saline shortage in late 2024 disrupted 10–20% of procedures, the company's installed base of 505 robotic systems in the U.S. provides a durable foundation for future growth.

Investment Thesis: A High-Conviction Play on Innovation

For investors, the stakes are clear. If the WATER IV Trial confirms Aquablation's efficacy in prostate cancer, PROCEPT could become a leader in urologic oncology, replicating the success of its BPH platform in a far larger market. The transition from BPH to oncology also diversifies the company's revenue streams, reducing reliance on a single indication.

The stock has already shown volatility, but its fundamentals are compelling. With 2025 revenue guidance of $320M (a 42% increase from 2024) and a growing installed base, the company is executing on its long-term vision. Analysts have set price targets ranging from $70 to $95, with a median of $84—a 23% upside from current levels.

Notably, PRCP has consistently exceeded earnings expectations since 2022, with a 100% earnings beat rate over the past year. A stable EPS surprise of $0.09 and consistent earnings release dates have further bolstered investor confidence, reinforcing the company's financial discipline and operational predictability. These metrics suggest a strong alignment between management's guidance and actual performance, a critical factor for risk mitigation in high-growth sectors.

Conclusion: The Future of Urology Is Minimally Invasive

PROCEPT BioRobotics is at the forefront of a paradigm shift in urology. By leveraging robotic precision, AI, and a focus on outpatient care, the company is not only improving patient outcomes but also reshaping the economics of prostate cancer treatment. The successful execution of the WATER IV Trial could cement Aquablation's role in the standard of care, unlocking billions in market potential.

For investors, this is more than a stock—it's a bet on the future of healthcare. As the trial progresses and the technology transitions from BPH to oncology, the question isn't whether PROCEPT can succeed, but how quickly it will dominate a market ripe for disruption.

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