Procept BioRobotics Balances Rapid Growth With Profit Push

Procept Biorobotics Corp. ((PRCT)) has held its Q4 earnings call. Read on for the main highlights of the call.

Procept BioRobotics’ latest earnings call balanced impressive growth in procedure volumes and system placements with candid acknowledgment of margin pressure, higher losses and a reset of revenue expectations. Management framed recent commercial changes and pricing moves as deliberate short-term trade-offs meant to sharpen visibility, raise average selling prices and lay the groundwork for sustainable profitability by 2026.

Surging Procedure Growth Underscores Strong Adoption

Procept reported about 12,200 U.S. procedures in Q4 2025, a roughly 69% year-over-year increase that signals accelerating clinical adoption of its HYDRO systems. This rapid volume growth is a key underpinning of the company’s long-term story, suggesting deeper physician engagement and broader penetration of its water-based BPH therapy.

Moderate Revenue Growth and Reset 2026 Outlook

Total revenue in Q4 2025 rose 12% year over year to $76.4 million, a slower pace than procedure growth due mainly to changes in ordering patterns. Management reset 2026 revenue guidance to a range of $390 million to $410 million, which still implies a healthy 27% to 33% increase over 2025 despite the new, more conservative assumptions.

Installed Base Expansion Fuels Future Utilization

The company sold 65 new HYDRO systems in the quarter, lifting the installed base to 718 systems, up 42% from the end of 2024. Q4 system revenue reached $27.6 million at a blended average selling price near $425,000, positioning Procept for continued procedure growth as newly placed systems ramp utilization.

Consumables Growth and Higher Handpiece Pricing

U.S. handpiece and consumable revenue climbed 16% year over year to $34 million in Q4, showing that recurring revenue is tracking with adoption. Average selling price for handpieces rose to roughly $3,340, up about 5% sequentially, and management now targets around $3,500 in 2026, a roughly 9% lift versus 2025.

International Markets Add Momentum

International revenue reached $9.8 million in Q4, up 25% from a year earlier, highlighting growing traction outside the U.S. For 2026, Procept expects international revenue of about $50 million to $51 million, underscoring the emerging role of global markets in the company’s growth profile.

Cash Balance Supports Growth Investments

As of December 31, 2025, Procept held $285 million in cash, cash equivalents and restricted cash, giving it ample runway to fund operations and expansion. Management emphasized that this liquidity underpins ongoing commercial build-out, R&D commitments and the planned glide path toward profitability.

Clearer Path to Profitability and EBITDA Improvement

The company forecast a 2026 adjusted EBITDA loss between $30 million and $17 million, narrowing meaningfully from current levels. Importantly, Procept expects to achieve positive adjusted EBITDA in Q4 2026 under both the low and high revenue scenarios, signaling confidence in a seasonal but improving profit trajectory.

Robust 2026 Procedure Volume Outlook

For 2026, management guided to 60,000 to 64,000 total U.S. procedures, representing about 39% to 48% growth versus 2025. This outlook suggests continued acceleration in utilization across the installed base, reinforcing the durability of demand even as ordering behavior is normalized.

Commercial Realignment and Launch Team Show Promise

Procept reorganized its commercial operations into integrated regions and created a dedicated launch team to drive faster ramp at new accounts. Early pilot data showed roughly a 50% reduction in time to first-line cases, with the company expecting this model to improve launch consistency and downstream utilization over time.

One-Time Field Action Largely Contained

Management detailed a voluntary field action in Q4 that carried about a $1.5 million impact but was addressed through a field upgrade. The issue did not involve patient safety and is not expected to recur, limiting its effect to a one-off drag on quarterly results.

Ordering Changes Hit Quarterly Revenue

The elimination of end-of-quarter bulk discounts prompted customers to reduce stocking, pushing handpiece sales to about 9,400 units or roughly 80% of procedure volume. This shift led to lower-than-expected Q4 revenue and reduced projected 2026 handpiece revenue versus historical models, but should yield more predictable, procedure-linked demand.

Q4 Gross Margin Under Pressure

Gross margin in Q4 2025 came in at 60.6%, down from 64.0% a year earlier and about 450 basis points below prior guidance. The one-time field action accounted for roughly 240 basis points of that pressure, while the rest reflected mix and near-term operational headwinds.

Higher Operating Expenses Weigh on Results

Operating expenses rose to $77.4 million in Q4 from $63.4 million in the prior-year period, as Procept continued to invest in commercial expansion and R&D. The company also increased funding for its Water IV prostate cancer trial, balancing near-term losses against potential long-term opportunities.

Net Loss Widens with Growth Investments

Net loss in Q4 2025 expanded to $29.8 million from $18.9 million a year earlier, highlighting the cost of scaling the business. The wider deficit reflects both higher operating expenses and margin pressure but is framed by management as part of a deliberate investment cycle.

Adjusted EBITDA Loss Reflects Margin and Cost Headwinds

Adjusted EBITDA loss reached $19.0 million in Q4, compared with a $10.3 million loss in the prior-year quarter. The deterioration stems from the same forces hitting net income, yet the company believes these pressures will ease as pricing, utilization and the new commercial model mature.

Higher 2026 OpEx and Tariff Drag

For 2026, operating expenses are expected to rise to about $350 million, roughly 17% higher than 2025, as Procept continues to fund growth and trials. In addition, anticipated tariffs of $5 million to $6 million represent about a 100-basis-point headwind to 2026 gross margin compared with 2025.

Short-Term Disruption from Sales Realignment

The commercial reorganization and launch-team rollout caused temporary account coverage gaps and fewer experienced sales resources in the field during the transition. Management acknowledged this as a near-term drag on execution but contends it should enhance scalability and field productivity once fully implemented.

Soft Start to 2026 Expected

For Q1 2026, Procept is guiding to 12,000 to 12,800 U.S. procedures, equating to roughly 29% to 37% growth, and revenue of $79 million to $82 million, up 14% to 19%. The company expects an adjusted EBITDA loss of around $20 million and describes 2026 as back-end loaded as new initiatives and systems ramp.

Lower Near-Term Handpiece Revenue Despite ASP Gains

While higher handpiece pricing offsets part of the change, the move to model units roughly one-to-one with procedures materially reduces expected handpiece revenue versus historical stocking patterns. Management estimated that maintaining prior stocking behavior could have added about $20 million to $22 million of revenue, underscoring the reset embedded in new guidance.

Updated Guidance Points to Growth and 2026 Inflection

Management reaffirmed 2026 revenue guidance of $390 million to $410 million, international sales of about $50 million to $51 million and 60,000 to 64,000 U.S. procedures, with U.S. handpiece ASP around $3,500 and units aligned with procedures. They expect full-year gross margin near 65%, operating expenses of roughly $350 million and an adjusted EBITDA loss between $30 million and $17 million, with EBITDA turning positive in Q4 2026 even as Q1 remains loss-making.

Procept’s earnings call painted a picture of a company trading near-term margin compression and commercial disruption for long-term visibility and profitability. With strong procedural and system growth, tighter alignment of consumables to actual use and a credible path to positive EBITDA, investors are being asked to stomach some near-term volatility in exchange for a potentially more durable growth story by 2026.