PROF

Good afternoon, ladies and gentlemen, and welcome to the Profound Medical Q1 2026 Financial Results Conference Call. At this time, all lines are in listen-only mode. Following the presentation, we will conduct a question and answer session. If at any time during this call you require immediate assistance, please press star zero for the operator. This call is being recorded on Thursday, May 7th, 2026. I would now like to turn the conference over to Stephen Kilmer, investor relations. Please go ahead.

Thank you. Good afternoon, everyone. Let me start by pointing out that this conference call will include forward-looking statements within the meaning of applicable securities laws in the United States and Canada. All forward-looking statements are based on Profound's current beliefs, assumptions, and expectations and relate to, among other things, any express or implied statements or guidance regarding current or future financial performance and position and expectations regarding the efficacy of Profound's technology. Such statements involve known and unknown risks, uncertainties and other factors that may cause actual results, performance or achievements to be materially different from those implied by such statements. No forward-looking statement can be guaranteed. Listeners are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this conference call.

Profound undertakes no obligation to publicly update or revise any forward-looking statement, whether as a result of new information, future events or otherwise, other than as required by law. Representing the company today are Dr. Arun Menawat, Profound's Chief Executive Officer, Rashed Dewan, the company's Chief Financial Officer, Dr. Mathieu Burtnyk, Profound's President, and Tom Tamberrino, our Chief Commercial Officer. With that said, I'll now turn the call over to Rashed.

Good afternoon, everyone, welcome to our First Quarter 2026 Conference Call. On behalf of the management team and everyone at Profound, I would like to thank you for your ongoing interest in our company. For those of you who are shareholders, we appreciate your continued interest and support. I will turn the call over to Mathieu in a moment to provide clinical updates. However, before I do, I would like to provide a brief summary of our first quarter 2026 financial results. All of the numbers I will refer to have been rounded, they are approximate. For the three-month period ended March 31, 2026, the company recorded revenue of CAD 5.3 million, with CAD 2.5 million from recurring revenue and CAD 2.9 million from one-time sale of capital equipment.

First quarter 2026 revenue was up 104% from CAD 2.6 million for the same three-month period a year ago. Gross margin in Q1 2026 was 72% compared to 71% in Q1 2025. The increase in first quarter 2026 gross margin was primarily due to product mix, whereby more capital equipment was sold, which contains a higher margin. Total operating expenses in the 2026 first quarter were CAD 11.8 million, down 9% from CAD 13 million in the first quarter of 2025. Overall, the company recorded a first quarter 2026 net loss of CAD 7 million, or CAD 0.19 per common share, compared to a net loss of approximately CAD 10.7 million, or CAD 0.36 per common share in the three months ended March 31, 2025.

As of March 31, 2026, Profound had cash of CAD 50.3 million. As Arun will discuss later in the call, we believe that we continue to be on a path to profitable growth. In keeping with that, we expect our cash burn to decline and eventually turn cash flow positive as our revenue continue to grow and our margin remains high. We continue to expect full year 2026 gross margin to be 70% or better, as indicated before. With that, I will now turn the call over to Mathieu for an update on clinical and development activities.

Thank you, Rashed, and good afternoon. Just a few weeks ago, we were joined by Dr. Laurence Klotz on a conference call to discuss the first clinical outcomes from the level 1 post-market CAPTAIN trial, comparing the safety and efficacy of the TULSA procedure with robotic radical prostatectomy in men with localized prostate cancer. Rather than going over all that information again, I invite you to see our press release dated March 13 and listen to the associated conference call replay, which is available in the IR calendar posted to our website. The CAPTAIN trial demonstrated that TULSA delivered statistically superior quality of life outcomes compared to radical prostatectomy, achieving its primary safety endpoint with statistically higher preservation of the composite endpoint of urinary incontinence and erectile function at six months.

In addition, patients treated with TULSA experienced superior perioperative outcomes, including no blood loss, no overnight hospital stay, less pain and faster recovery, along with statistically significantly fewer serious complications and a faster return to normal activities and paid employment. These positive outcomes from CAPTAIN sit on top of an already solid clinical foundation. TULSA is supported by more than 70 peer-reviewed publications and over 200 scientific conference presentations. Importantly, this body of evidence wasn't built in a single way or for a single use case.

Rather, we've supported both sponsored and investigator-initiated trials to demonstrate that TULSA is not only effective but flexible and customizable across whole gland treatment, partial gland treatment, large prostates, salvage settings, combinations of cancer and BPH, and patients with BPH alone. Our open international care registry captures this spectrum as any patient treated with TULSA, regardless of disease state, is eligible to be included.

The takeaway is clear. TULSA is not a niche solution. It's a platform that can be applied in many different ways while delivering consistent, predictable, and durable outcomes. CAPTAIN completes the final foundational pillar of clinical evidence validating TULSA as a new platform for prostate disease management. From gold standard treatment effect data to tact durable five-year outcomes, CAPTAIN now positions us to demonstrate with statistical rigor TULSA's superior quality of life profile while delivering whole gland treatment efficacy. As Arun will review next, TULSA is solving the debate between focal and whole gland treatment for prostate cancer. I will now turn the call over to Arun.

Thank you, Mathieu, and good afternoon, everyone. While Tom is here to participate in the Q&A as usual, to help streamline things, I will personally cover the business section today. As I discussed in our Q4 call, the dynamics in the prostate disease treatment space continues to change at a decent pace. Whole gland robotic prostatectomy or radiation therapy are the standard of care for treating prostate cancer today. For BPH, mainstream treatment with transurethral resection of the prostate, or TURP, has largely been unchanged over the past 100 years. It is our belief that today's standards have plateaued and that we can do better than the clinical outcomes of these standards. The initial CAPTAIN data that Mathieu just talked about is a clear example of the potential of our TULSA technology. As you know, many alternative technologies are competing to try to unseat today's standards.

While we believe it is great to see such innovation, it is also important to present to you how TULSA stands in its capabilities as compared to today's standards as well as multiple focal therapies. I would like to share with you a few of the key unique aspects of the TULSA technology. We publish every quarter the types of patients that are being treated using the TULSA procedure. Starting this quarter, that information has been tabularized for easier review, comparison, and follow-up. The commercial data clearly shows that about 91% of TULSA patient prostates are treated either as whole gland or more than 50% of prostate ablations. The remaining 9% are focal therapy cases. We have been publishing this information for the last several quarters, but it is more relevant today than ever before.

The point is that TULSA is the most versatile and flexible technology that empowers the urologist to personalize the treatment to fit each patient's situation. This turns the previous paradigm, with urologists having to match the right subset of patients that are the most suitable candidates for a particular treatment modality on its head. We believe that this is a major advantage to drive adoption of TULSA. Another uniqueness of TULSA is what I described in the recent presentation at the Bloomberg conference, where I showed a picture of a leading urologist, Dr. Klotz, treating a patient comfortably leaning in his chair with a half-eaten apple in one hand and the TULSA computer mouse in the other. That, frankly, is the future of surgery. Based upon the feedback we are getting, the TULSA procedure is the least stressful procedure of any that a urologist performs today.

Another topic that has been discussed in more detail lately relates to the energy source that is deployed by the various alternatives. Since we capture the real-time tissue temperature using the MR, the TULSA technology is tuned to heat the tissue only to 57 degrees Centigrade, at which point, the tissue dies instantly. This is therefore the minimal energy deployed for maximum impact. Any other technology in comparison is either heating the tissue to the point of boiling or charring, which has its own side effects, or cold cutting the tissue, in which case the tissue DNA is not dead. The science correlates the TULSA technology to improve safety and clinical outcomes data of the TULSA procedure based upon evaluation in over 70 publications on a variety of prostates.

We believe strongly in the 10% theory that says that we will achieve an inflection point as we convert at least 10% of the patient population. We are growing at a faster pace than the growth rate of prostate cancer, and accordingly, we're clearly advancing towards the 10%. And although we're not there yet, we believe it is only a matter of time. As far as the comparison to alternatives, we believe that while each will find their own sweet spot in time, only TULSA has the true potential of becoming a mainstream treatment modality. One of the pillars of our growth strategy is to continue to demonstrate the flexibility and capability of TULSA. To demonstrate consistent progress of TULSA adoption, you will see two tables in our quarterly press releases.

The one I just mentioned in the variety of patients where TULSA treatment applies, which is a good indicator of total TAM. The second one, a new TULSA Index table, which will be a good indicator of the growth of same-store sales. We have picked 20 sites to make up the index that has been using TULSA for at least a year and represent what we believe is the appropriate mix of different types of customers, including large hospitals, smaller hospitals, and private practice users, and which will likely be most reflective of the future installation mix. These are not necessarily the most active sites today. By showing you five running quarters, the idea is to show the rate of growth of same-store sales. We will also continue to publish the install base, which we believe will function as an indicator of future utilization growth.

The next point that I would like to talk about is the use of the MR by TULSA, as there is a bit of confusion about that. It is true that as we started commercialization, finding compatible MR, available time, and convincing urology and radiology to work together to start a TULSA program has been a major hurdle to climb. Today, TULSA is compatible with an installed base of about 4,000 MRs in the U.S. and more worldwide, and that number continues to grow. It is therefore a lot easier to find an MR and justify TULSA, particularly with the economic proposition, as its facility fee is higher than that of any other treatment modality. Our relationship with MR companies also continues to expand as they see interventional MRs as a growth opportunity for them too.

We are delighted to be working with these large companies as partners with aligned goals. As we have talked about in the past calls, MRs specifically designed for interventional procedures are now becoming commercially available. These MRs are significantly smaller, lighter, and easier to use to the point that even an MR tech is not necessary to operate them. They are also less costly to acquire and maintain and can be placed just about anywhere since they don't need the same shielding as large magnets. The Siemens Free Series, which is a prime example of such an MR, is now available, and Cook Medical is partnering with them to provide a turnkey iMRI solution to hospitals. We believe that TULSA is the natural king app for the interventional MR, as it makes the economic justification of the iMRI suite very compelling.

At this point, we anticipate that if all goes well, TULSA will get FDA clearance for integration with the new interventional MR by year-end, and we believe that this will meaningfully contribute to our growth in 2027. Considering all of this, we believe our goal of achieving 200 TULSA sites performing an average of at least 50 cases per year to achieve profitability remains achievable, and we remain committed to this strategy.

Finally, we would like to invite you to come visit us at the upcoming American Urological Association meeting that starts on Friday, May 15th, in Washington, D.C. For the first time, there will be a real Siemens Free Series MR in our booth, and you will be able to see the future first hand. To summarize, Profound is pioneering iMRI procedures which enable precise incision-free therapies that improve clinical confidence, procedure control, and patient outcomes.

By leveraging real-time MRI guidance, Profound's technologies are designed to replace uncertainty with clarity across treatment planning, delivery, and confirmation. The TULSA-PRO install base was 80 at end of Q1 2026, and we shipped an additional six systems during the first quarter that have yet to be installed. In prostate disease, we believe we're now crossing the chasm by transitioning TULSA from early adopter customers to the mainstream market by establishing the technology as a third distinct category that doesn't make surgeons or their patients choose between whole gland or focal therapies, because TULSA can do both and anything in between. As we said in today's press release, we are currently projecting total revenue for full year 2026 to be approximately CAD 25 million, which represents 56% growth compared to last year, together with 2026 gross margin of 70% or higher.

We continue to believe that we are on the path to profitable growth. This ends our prepared remarks for today. With that, we're happy to take any questions you might have. Operator?

Thank you. Your first question comes from Ben Haynor with Lake Street Capital Markets. Please go ahead.

Good afternoon, gentlemen. Thanks for taking the questions. First off for me, congrats on the getting Humana to begin paying for this. Can you share maybe any color on that? Is it the CAPTAIN data that tipped them over? Is it anything specific that led to their coverage decision? Then where do you see kinda some of the other commercial payers in this whole progression?

Ben, thank you very much for the question. Can you hear me okay? This is Tom Tamberrino.

I can, Tom. Thanks.

Okay, perfect. Just wanted to make certain. First, thank you for recognizing the tremendous announcement specific to Humana, and there are several others that we were able to gain coverage with here in Q1 of 2026 via the efforts of our health economics and market access team led by Kelly Petrucci and Tracy Davis. They did a phenomenal job. What I can tell you, Ben, is that it is the combination of all of the publications, now 70 plus, that are allowing us to get an audience with the medical directors of private insurers here in the United States and then leverage that data to have a discussion, much like the position that Arun just stated as to where TULSA-PRO fits in in the continuum of care for prostate disease. It's not one specific thing.

It's a compilation of all of the work that's been done over the years to put us in the position we're in today. We're very excited, as the rate that we're seeing is roughly 1.5 to 2.5x Medicare as it relates to private insurers based on the geographically appropriated GPCI rates, which is in line with what most industry standards would be.

Excellent. That's very helpful. Then, I guess following up a little bit on that, do the folks that haven't announced, I guess, formal coverage policies, are you still seeing the same sort of general coverage that you had been seeing, you know, really up until now?

Obviously we go back to January 1st, 2025, when Medicare provided coverage for TULSA-PRO, and that has allowed us to begin to have these discussions with the medical directors of the private insurers here in the United States. In combination to that, which should be no surprise, we also have a patient access team led by Stephanie Slater, and we do hand-to-hand combat with the private insurers on a case-by-case basis. We've been very successful, winning approximately 80% of the cases that we're involved with. My understanding of industry standard is somewhere between 50%-60%.

I think that speaks to the talent of Stephanie, but also the growing body of evidence that TULSA-PRO is another tool in the armamentarium of physicians to treat prostate disease in between where focal therapy ends and prostatectomy and/or radiation begins is really where our sweet spot is starting to take fold.

Got it. No, that's great. Last thing for me, just kinda housekeeping on the six shipments that were shipped but not installed. Do we expect those to hit revenue in the current quarter, or is that something that would have been included in Q1 or half and half? How does that shake out?

Ben, on that particular point, we're trying to sort of be a bit more granular than we have been. You know, I just wanna clarify exactly what we're doing. The total number of systems that we sold is Eight. So, eight systems were sold. Two of them were installed, we increased the install base to 80. Six of them were shipped, they're not installed yet. Right. We do recognize revenue when we ship them, we also realize that they won't be treating patients right away. That's the reason why we made that distinction.

Okay. That's helpful. That's it for me. Thank you, guys, and I'll see you at AUA.

Beautiful, Ben. Thank you.

Your next question comes from Michael Freeman with Raymond James. Please go ahead.

Hi, good afternoon, Arun, Mathieu, Rashed, Tom, Steve. Congratulations on the quarter. I wonder if we could talk about the guidance. We appreciate that you did set formal guidance here.

Yeah.

You know, I wonder if you could describe what informed this outlook. I recognize that this, you know, seems conservative relative to street expectations. I wonder if you could just give us a bit more color on how you came to this number?

Yeah. Very, very happy to talk about this. You know, first of all, we are very bullish on our business. In fact, we've never been more bullish. You know, Tom can describe more about the pipeline as well. To me, it is now about discipline. You know, we're putting a stake in the ground for the first time as proper guidance, right? We have provided targets before, but this is the first time we're putting a proper number on the table. You know, we will continue to work hard as we always do. If we can drive it faster, we absolutely will. If that happens, we will most certainly come back and hopefully increase the guidance.

I think, as I said, it really is the business is jelling, and we feel that we need to provide appropriate discipline. Look at this as more of a starting point, and we will adjust as we go.

Okay. All right. Well, thank you. Yeah, My next question was gonna be on the status of the pipeline. I would appreciate some commentary on your funnel.

Yeah. Tom can absolutely describe that.

My pleasure. Thank you. Michael, thank you for the question. Happy to report that our pipeline remains strong. It's north of triple digits across our verified, negotiate, and contracting stages of our sales process. These pipeline accounts are representative of similar attributes to our Index 20 that we've shared here today and will continue to share in the quarters that follow.

Okay. Great. Thank you very much. Maybe the last one. I wonder if you could dig into the TULSA Index a little bit. Maybe describe, you know, I see that you provide, you know, averages of the index for utilization.

Right.

How would you describe maybe the range on annualized procedures that we see in the index? How do you plan to maintain this index? Will it be a rebalancing should there be outliers in the future? Any commentary would be helpful.

Sure. You know, again, we are... Things are jelling. So we are trying to become as transparent as possible. This is our first shot at it. Let me provide a little bit more context. What we really did was we said, okay, what are the types of company, of hospitals, large, small, you know, private practice and so on? What would that mix look like? Then we sort of looked at the current install base, and we segregated the sites that had one year experience. The 20 sites that we picked are really designed to reflect what we think the future install base will look like.

If we can demonstrate that the same-store sales in these 20 are increasing quarter-over-quarter. What we will do is we'll provide this rolling five quarters, so you will be able to see the change, you know, over, you know, the basically the trend. As time goes on, we will go from an index of 20 to index of 30 to 50 to hopefully to 100. That's the idea. It will, you know, allow you to sort of see that progress and hopefully it will mirror the future. Is that helpful?

Excellent. It's very helpful, and I appreciate you providing the TULSA Index. I'm gonna pass the line. Congratulations.

Thank you.

As a reminder, if you wish to ask a question, please press star one. Your next question comes from Scott McAuley with Paradigm Capital. Please go ahead.

Thanks, everyone. Thanks for taking the questions. I just wanted to check in on the kind of capital sale model, whether or not I know you've spoken in the past that that's kind of the preferred model going forward. Is that still the case, you're finding, your potential customers interested in acquiring the capital, versus a more placement or lease model for the system?

Scott, thank you very much for the question. This is Tom answering. You know, our capital model is very much in line with what I believe to be industry standard from my experience, is that roughly CAD 100 of capital equals CAD 10 of service equals CAD 1 of consumables. When we're speaking with hospital administrators, C-suite, CFOs specifically, they totally get the way that we have the capital model situated, and that has been the large majority of the systems that we sold in Q1. We did sell eight systems. As Arun mentioned, two were installed, and six were shipped that were not installed. Out of those, only one was on the placement model that we spoke about with a bulk purchase.

I believe we spoke about it in either Q3 or Q4's earnings call from 2025. That represents roughly 10% of the recurring revenue for the quarter of Q1.

That's great. Super helpful. Thank you. I know, you know, now you're talking about the guidance, the CAD 25 million in revenue. I know in the past, there'd been reference to a target of, you know, approximately 120 installations, I believe, for the end of 2026. Does that, you know, is that 120 still representative of the target and help inform that, you know, CAD 25 million revenue guidance for this year?

Scott, there is no change of any sort. We are still shooting for that 120. As I said before, we are working hard to be much more disciplined and start to provide quantifiable information in every place we can. There's no change in our pipeline. There's no change in our target install. There's no change in the potential of our company. If anything, as I said, we remain really bullish. The number that I provided is just a stake in the ground that we put in so that we can, you know, anchor it someplace and adjust as we go. Hopefully that addresses your key question.

Yep. No, appreciate that. Lastly, circling back to the reimbursement, again, great to see the private payers starting to come in. Any comment on the reimbursement rate that you're getting, if you're happy with that, kind of relative to what Medicare is paying, and if you see kind of the Humana rate as the target going forward as other private payers come online?

Yeah. Scott, as Tom mentioned already, what we are seeing is generally between 1.5 and 2.5 of what Medicare is paying. We are very happy with that range. The typical range is from, again, from benchmarks that we see is closer to 1.5, but we're pretty happy to see that in our case, some of them are actually even paying more than 2.5. I think over the long haul, that range is a pretty good place to model. Just to provide a little more color on this, you know, Humana is one of the top five payers.

The way this process works, to some extent, as Tom already described, you know, you're working hard to make sure any patient who's been rejected, that they, you know, the appeal process goes on, and we see an 80% success rate in reversing those decisions. Now we have the first major payer that has put the coverage decisions. Overall, frankly, we are bullish about other insurance companies that will now start to follow suit from this as well. I think generally speaking, it's the hardest to get the first big one, and I think Tom and his team did a great job to get there. I do think that other insurance companies will follow.

That's great. If I may squeeze in one last one, I apologize.

Yeah, please

Just in terms of the guidelines. I know, you know, being included in kind of AUA or other society guidelines is, you know, an important driver. I believe there have been some commentary around, you know, that being a kind of late 2026, early 2027 kind of goal, or at least seeing momentum there. Are there any update on that process?

Yeah. Thank you for the question. This is Mathieu speaking. On the guideline front, you know, it's a continuous process. We described in one of our previous calls that the TULSA procedure is now being named in the NCCN guidelines, which is probably the premier set of guidelines in this space. That's already a step in the right direction, where TULSA is being named by hand. They're recognizing the value of the TULSA procedure under clinical trial or registry. We do have our international care registry where we invite, you know, all of our centers to participate in. We do see a lot of positive momentum from that. Together with as Tom and Arun were describing on the Humana side, it does relate to the totality of evidence.

It's not just CAPTAIN, it's a totality of evidence. With the 70 peer-reviewed publications, when insurance companies come to the table and do their literature searches, they do see that those publications come up and help them with their decision-making. With Humana coming in, we do expect to see other insurance companies coming in based off of that. As we continue to publish CAPTAIN data, we do anticipate that whether it's the NCCN guidelines, the AUA guidelines, the EAU guidelines, they'll start to also recognize TULSA by name and then start to recommend it for certain population subsets. Over time, we anticipate that to grow into larger population subsets as well. I'm not sure if that answers your question, but that's where we sort of see the progression of the guidelines.

Yep, no, that's helpful. Appreciate it.

There are no further questions at this time. I will now turn the call over to Dr. Menawat for closing remarks. Please continue.

Thank you. Again, for those of you who can visit us at the American Urological Association meeting, in Washington next week, please do join us and, we will have demos. We'll have the Siemens MR in the booth. We'll be describing how all of this will work together in an integrated fashion. Thank you again and look forward to seeing you soon.

Ladies and gentlemen, this concludes today's conference call. Thank you for your participation. You may now disconnect.

Good day, and thank you for standing by. Welcome to the Profound Medical Fourth Quarter 2025 Financial Results Conference Call. [Operator Instructions] Please be advised that today's conference is being recorded. I would now like to hand the conference over to your speaker today, Stephen Kilmer, Investor Relations. Sir, please go ahead.

Thank you, and good afternoon, everyone. Let me start by pointing out that this conference call will include forward-looking statements within the meaning of applicable securities laws in the United States and Canada. All forward-looking statements are based on Profound's current beliefs, assumptions and expectations and relate to, among other things, any expressed or implied statements or guidance regarding current or future financial performance and position, and expectations regarding the efficacy of Profound technology. Such statements involve known and unknown risks, uncertainties and other factors that may cause actual results, performance or achievements to be materially different from those implied by such statements. No forward-looking statement can be guaranteed. Listeners are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date of this conference call. Profound undertakes no obligation to publicly update or revise any forward-looking statements whether as a result of new information, future events or otherwise, other than as required by law. Representing the company today are Dr. Arun Menawat, Profound's Chief Executive Officer; Rashed Dewan, the company's Chief Financial Officer; Dr. Mathieu Burtnyk, Profound's President; and Tom Tamberrino, our Chief Commercial Officer. Please note that our prepared remarks today will be a little longer than normal as we present to you the dynamics of the market and our strategies to create a profitable growth company. With that said, I'll now turn the call over to Rashed.

Good afternoon, everyone, and welcome to our Fourth Quarter and Full Year 2025 Conference Call. On behalf of the management team and everyone at Profound, I would like to thank you for your ongoing interest in our company. For those of you who are shareholders, we appreciate your continued interest and support. I will turn the call over to Mathieu in a moment to provide commercial updates. However, before I do, I would like to provide a brief summary of our fourth quarter 2025 financial results. To streamline things, all of the numbers I will refer to have been rounded. So they are approximate. For the 3 months period ended, December 31, 2025, the company recorded revenue of $6 million, with $2.3 million from recurring revenue and $3.7 million from onetime sales of capital equipment. Fourth quarter 2025 revenue was up 43% from $4.2 million for the same 3-month period a year ago. Gross margin in Q4 2025 was 67% compared to 71% in Q4 2024. The lower than usual fourth quarter 2025 gross margin was primarily due to product mix and new market introductory prices with international distributors in Saudi Arabia and Australia. Total operating expenses in the 2025 fourth quarter, which consists of R&D and SG&A expenses were $11.4 million compared with $11.3 million in the fourth quarter of 2024. Overall, the company recorded fourth quarter 2025 net loss of $8.2 million or $0.27 per common share, compared to a net loss of approximately $4.9 million or $0.20 per common share in the 3 months ended December 31, 2024. As of December 31, 2025, Profound had cash of $59.7 million. As Arun will discuss later in the call, we believe that we are now on a path to profitable growth. In keeping with that, we expect our cash burn to decline and eventually turn cash flow positive as our revenues continue to grow and our margin remains high. With that, I will now turn the call over to Mathieu for an update on clinical and development activities. [Technical Difficulty]

Again, I'm sorry, let me cover Mathieu's part here. So again, Mersa, thank you. Last year, we completed recruitment in CAPTAIN, the first multicenter, randomized, controlled trial directly comparing a new technology to robotic radical prostatectomy for men with localized prostate cancer. CAPTAIN completes the foundational pillars of clinical evidence, validating TULSA as the new platform for prostate disease management. From gold-standard treatment, treat and resect data through track durable 5-year outcomes, CAPTAIN now positions us to demonstrate with statistical rigor, TULSA's superior quality of life profile while delivering whole-gland treatment efficacy. CAPTAIN was designed for world-leading -- I'm sorry, CAPTAIN was designed by world-leading experts in prostate cancer clinical trials. They built a practical study that ensured successful enrollment and more importantly, a scientifically robust protocol with endpoints that matter to patients, clinicians and payers. Let me repeat that point. CAPTAIN's endpoints are those that matter to the patients, the clinicians and the payers. Patients were randomized 2:1 using an intelligent stratification algorithm, resulting in highly balanced arms, a cornerstone of credible randomized trials, balanced arms allow us to make definitive comparative conclusions about safety and efficacy. And critically, CAPTAIN measures efficacy in a meaningful way, determining whether clinical significant cancer remains after treatment. Patients and their oncologists want to know whether cancer has been killed and eliminated not merely whether it had progressed. As discussed last quarter, completing treatments in CAPTAIN locks in the timeline for data readouts, including the imminent release of preliminary -- imminent release of primary safety and quality of life endpoints. Last year, we shared initial perioperative outcomes showing faster recoveries after TULSA than robotic prostatectomy with 0 blood loss or overnight hospitalization, reduced pain, and earlier return to daily function and overall health. These advantages echo the same drivers that fueled early adoption of robotic surgery.

Thank you, for taking over. I can jump back in if you want?

Okay. Go ahead.

I'll go ahead. So ahead of schedule, we will present the first clinical outcomes from CAPTAIN next week at the meeting of the European Association of Urology in London, U.K. EAU is the premier academic urology meeting, and we were pleased that our data has been selected for inclusion in the late-breaking and the high-impact session. The presentation will be delivered by Dr. Laurence Klotz on Friday, March 13, between 1:00 and 3:00 p.m. Greenwich Mean Time, which is 8:00 to 10:00 a.m. Eastern time. These data include complete 90-day perioperative results and the 6-month primary safety and quality of life endpoints. Six-month quality of life outcomes are an increasingly important and modern endpoint. They reflect meaningful patient recovery and provide a more relevant early indicator of functional preservation. At EAU, we will report 6-month urinary incontinence rates, the single most important quality of life outcome for patients, along with 90-day hospital readmissions and time to return to work. At EAU, we will also report positive surgical margin rates in the prostatectomy arm, which we will later compare against TULSA biopsy outcomes in late Q4. CAPTAIN provides the first true apples-to-apples comparison of safety, quality of life and efficacy, the information required to support a new treatment paradigm. CAPTAIN is the most comprehensive truly Level 1 trial. But let me also take the time to outline the fundamental differences between CAPTAIN and other ongoing studies, namely WATER IV, FARP and HIFU. First, WATER IV. WATER IV is a multicenter randomized trial comparing Aquablation to radical prostatectomy in men with low- and intermediate-risk localized prostate cancer. The inclusion of low-risk patients is a critical distinction because these men harbor minimal disease and are unlikely to progress within the study's follow-up period, limiting any meaningful assessment of cancer control. Equally important is what the trial measures. WATER IV's primary endpoints are quality-of-life only. That means that the study is not designed or powered to demonstrate comparative oncologic efficacy. This is particularly notable considering there are no other peer-reviewed data using the Aquablation procedure to eliminate cancer in prostate cancer patients. The trial includes a single cancer-related secondary endpoint assessed only in the Aquablation arm, which is the stable or improved grade group at 1 year versus baseline. In practice, that means a patient who entered the study with grade Group 3, an unfavorable intermediate risk clinically significant cancer will be counted as a success even if the same grade Group 3 disease remains after treatment. That is not the same as a limiting cancer or even improving the cancer grade, and is not a randomized head-to-head efficacy readout. Frankly, this is not a Level 1 cancer trial. Next FARP. The focal ablation versus radical prostatectomy study. FARP is a single center European trial, which inherently limits generalizability to broad clinical practice, particularly to high-volume U.S. surgeons. Its population like WATER IV includes low and intermediate risk patients with disease localized to one side of the prostate. While FARP does include a comparative efficacy measure, the bar is not oncologic eradication. The focal therapy arm is deemed effective if patients avoid upgrading to grade Group 4. In other words, men who start with grade Group 1, 2 or 3 are considered successfully treated as long as they do not progress to grade Group 4. This is a very different endpoint than [ curing ] and eliminating clinically significant cancer. Even though TULSA was part of the study and to the best of our knowledge, the TULSA arm did better than any other arm, including HIFU, the reason we think is that not the most credible study is the endpoint itself. Avoiding upgrade is not the same as proving cancer has been cleared. Patients want to know plainly whether they still have cancer or not. Lastly, HIFU, a large multisite French comparison of HIFU versus prostatectomy did not randomize patients and therefore, is not considered a Level 1 trial. The result is significant selection bias and unbalanced arms. For example, HIFU patients were on average roughly a decade older than surgery patients. Age differences directly confound the study's primary endpoint of salvage treatment-free survival and erectile function. Older patients are less likely to undergo salvage treatment. Older patients have lower baseline erectile function, which means they have less function to lose after treatment. Without balanced randomization, you cannot make definitive comparative conclusions. Let me conclude. TULSA is solving the debate between focal and whole-gland treatment for prostate cancer. CAPTAIN measures efficacy to the same standard as robotic surgery, an essential requirement to establish a new standard of care. TULSA is the only technology capable of whole-gland, focal and customized treatment. Patients often choose focal therapy to preserve quality of life. With TULSA, patients achieve the benefit of focal side effects with the efficacy of whole-gland treatment. I will now turn the call over to Tom.

Thank you, Mathieu. As Rashed mentioned, we achieved a year-over-year revenue increase of 43%. We had 78 TULSA-PRO sites as of December 31, 2025. The company's TULSA-PRO qualified sales pipeline is also growing and currently stands at 110 new systems being classified within one of the verify, negotiate and contracting stages, which are the final 3 phases of our sales process. Q3 2025 was a true commercial inflection point, and we saw the momentum continue in Q4. We're continuing to see broader adoption of TULSA-PRO across both academic and community hospitals. That's largely due to increased awareness of the system's clinical benefits and the establishment of a reimbursement pathway made possible by the Category 1 CPT codes for the TULSA procedure. TULSA reimbursement was confirmed again for 2026 at urology Level 7, which is appropriate as TULSA utilized real-time MR, which is crucial to better clinical outcomes. Our team has also initiated engagement with private insurance carriers, and we expect coverage decision from carriers in the second half of 2026. Our global commercial leadership team has never been stronger than it is today. This includes sales, marketing, business development, health economics, market access, patient education, patient access, clinical service and strategic initiatives. We have a world-class team of professionals here in the U.S. and around the world. It is noteworthy that we have launched a strategic TULSA program team, which will use our organizational leverage to ensure successful TULSA program launches and this team will grow procedural volume thereafter. Our team remains focused on targeting high-volume urology centers and supporting physician training. We're leveraging positive clinical outcomes and patient testimonials to drive engagement and deepen relationships with our customers. Looking ahead, I'm confident in our ability to further accelerate this growth. We're well positioned to capitalize on the expanding interest in image-guided interventions and we continue to scale our commercial footprint while validating our technology in the prostate care market. And as Arun will also highlight, there are a number of important catalysts coming in 2026, that continue to drive our relief that we will reach high double-digit to low triple-digit revenue growth. Importantly, we believe we are now on a path to not just growth but profitable growth with this selling approach. The math to achieve this target is simple, with just 200 TULSA programs cases using existing MR installed base, assuming a conservative 50 TULSA procedures per site per year and a $5,500 recurring revenue to Profound per procedure, we would be at $55 million in procedural revenue. Add on to this $10 million in annual service revenue, and another $20 million in new capital sale revenue based on an estimate of 40 new TULSA-PRO systems sold per year at an average sales price of $500,000 per system. Altogether, this will put us around $85 million in annual revenue. With 70% plus gross margin already achieved, we would be profitable. We're also building strategic partnerships on a global basis. Recent distribution agreements with Al Faisaliah Medical Systems in Saudi Arabia and Getz Healthcare in Australia and New Zealand have already started to bear fruit with multiple systems sold in Q4 2025. Our partnerships with OEMs such as Siemens, are also progressing well, and there's more exciting opportunity to come on the partnership front as 2026 progresses. Thank you for your time. I will now turn the call over to Arun.

Thank you, Tom, and good afternoon, again. Prostate cancer treatment has been a bipolar world up till now. Whole-gland robotic prostatectomy or radiation therapy are the primary tools for treating prostate cancer today. Trying to take some share away from these mainstream whole-gland modalities are focal therapy alternatives such as HIFU, cryoablation and IRE that treat typically less than 35% of the gland by focusing only on the visible cancer within the prostate. But TULSA is establishing itself as a third distinct category. TULSA-PRO can treat the whole-gland, a small portion of the gland and everything in between. At the same time, the TULSA procedure provides the best of both worlds. The same good clinical outcomes of whole-gland prostate cancer treatment but with lower side effect of focal gland treatment. The fact that the TULSA procedure is a third category all by itself is an important message. But it can be difficult for urologists and hospitals to understand the differences as they're getting bombarded by the focal messages from multiple companies. Difficult, but not impossible. Virtually, all surgeons who have used both TULSA-PRO and other technologies have ended up favoring TULSA by far because of its expanded capability to treat the full spectrum of prostate disease while minimizing quality-of-life side effects like urinary incontinence and erectile dysfunction. Today, we believe that whole-gland robotic prostatectomy and radiation therapy have run their course. And alternative focal prostate therapies are not enough. The TULSA-PRO system stands apart in its proven ability to treat the full spectrum of prostate disease as well as providing better economics to providers and more value to payers. TULSA uses real-time MR imaging that has several significant clinical and economic advantages. First, the real-time MR thermometry enables continuous visualization and autonomous temperature adjustment throughout the procedure. This level of precision allows the physicians to tailor therapy to each patient while minimizing side effects typically associated with robotic surgery or radiation. Second, MR produces standardized to the cross-sectional images enabling AI analysis unlike what may be possible using other imaging modalities, such as ultrasound. Using this capability, TULSA-PRO incorporates an AI-based treatment plan. Upon one click, the AI software segments the prostate and shows the surgeon a treatment design while keeping the nerve bundle and the sphincter muscle region safely outside the boundaries. Using a digital pen, the surgeon can either accept the AI-generated plan or quickly modify it, if necessary, making overall treatment planning fast and reliable. The TULSA-AI contouring assistant is based upon treatment designs by the best-known radiologist and is proven to be superior to surgeon designs. Third, MR enables real-time temperature monitoring. Using this capability and directional ultrasound from a catheter placed in the urethra, TULSA-PRO, gently heats tissue only to kill temperature between 55 to 57 degrees centigrade without boiling or charring the tissue. The net effect is that the whole-gland or any surgeon prescribed region can be treated effectively and the dead tissue is reabsorbed by the body. In the FDA registered TACT clinical trial, post-treatment prostate size was measured over time. The data showed that the median reduction in prostate size was 91% by effectively shrinking the prostate around the urinary channel, which is proactively protected during the procedure. Fourth, TULSA-AI enables cleaner margins. During TULSA procedure, real-time MR enables the treating surgeons to see abundance of cancer in the prostate. If necessary, the surgeon can engage another TULSA-AI module, Thermal Boost to apply additional heat to the region and ensure [ kill ] temperatures to the outer margin of the prostate or even slightly beyond the margin. Fifth, not to confuse things, we believe even TULSA partial gland or focal procedures are superior to other focal modalities, which all rely on ultrasound imaging. TULSA procedures are based upon real-time MR diffusion and T2 images. These images combined together visualize the abnormal cell regions of the prostate, which may be cancers. This real-time visualization allows surgeons to define the treatment region to completely include the suspicious zones, thereby increasing the likelihood of a more durable focal/partial gland treatment while maintaining minimal side effects. And finally, advanced real-time MR imaging provides confirmation and precision of cell kill at the end of the procedure, no matter what the intent to kill it in turn improves predictability of outcomes. To summarize, TULSA-PRO solves a debate about whether prostate cancer treatment should be whole-gland or focal without compromise. TULSA-PRO can be used to treat the whole-gland, a small portion of the gland or anything in between in large prostates, small prostates or even radio recurrent prostate, and with the clear benefit of MR imaging and guidance. And it is being used successfully to treat low, medium or high-risk cancers as well as salvage cases. Switching briefly to BPH. Mainstream treatment with transurethral resection of the prostate or TURP is largely unchanged over the past 100 years. Many alternative treatment methods have emerged that aim to improve the patient experience and reduce the rate of complications such as bleeding, erectile dysfunction, loss of ejaculation, and the need to stay in the hospital overnight for 1, 2 or more days. As demonstrated in the recently published study from the University of Turku, TULSA offers significant improvements in International Prostate Symptom Score, peak urine volume rates and discontinuation of BPH medications. That said, while urologists have been treating lots using TULSA-PRO since we received 510(k) clearance in 2019, and the technology is only 1 capable of treating hybrid patients suffering from both prostate cancer and BPH. Our BPH patient volumes have been low to date due to the relatively larger treatment duration compared to other modalities. The latest TULSA-AI module volume reduction is changing the BPH treatment paradigm. TULSA-AI volume reduction is designed to maintain all of the many proven advantages of treating cancer with TULSA, while leveling the playing field on the time it takes for a urologist to plan and complete the procedure by quickly identifying the overgrowing region of the BPH. The software streamlines the workflow and reduces procedure times to 60 to 90 minutes. Adoption of TULSA-PRO is also making more and more business sense. The economic proposition of an interventional MR has become stronger as of January 2026. CMS has studied reimbursement for prostate biopsy and made the determination that reimbursement for real-time MR in-bore biopsy should be separated from the method, which is prevalent today, which uses real-time ultrasound with prior diagnostic MR image registered to it. This allows the surgeon to visualize the cancerous region through the registered MR image, but have the convenience of ultrasound to perform the biopsy. While this technique is better than one where MR images are not used, clinical data shows that registration of MR images still create an error of about 20%. For that reason, CMS has now provided separate reimbursement for real-time in-bore MR biopsy as it is more accurate but more costly to perform. The reimbursement for a standard MR registered ultrasound image biopsy is about $3,500, whereas reimbursement for the real-time MR biopsy has been set at about $5,500, which is 57% higher. This is a huge change, and the implication is just beginning to get attention. And comparing Medicare national average payments hospital reimbursement for the TULSA procedure in 2026 is $13,479 compared to $10,860 for robotic surgery and $9,672 for focal therapies like HIFU and cryoablation. So now at the start of 2026, there is superior reimbursement for both in-bore MR prostate biopsy and the TULSA Procedure. Putting all this together, our thesis that the future of prostate disease care will be MR centered is coming true. This sufficient clinical evidence -- there is sufficient clinical evidence that if prostate cancer is visible on an MR, it should be treated immediately, making iMRI, in-bore biopsy and diagnostic modality of choice. Typically, there are 3 to 5 biopsy procedure performed for each one prostate cancer treatment and whereas there are about 1 million prostate biopsies done every year. No one single prostate cancer treatment modality is currently used for more than 100,000 patients per year. Doing the math, there is currently a clear disconnect between the preferred MR-guided diagnostic approach and mainstream treatment modalities. We believe only TULSA is suited to bridge that gap as we move forward. Our strategy in the near term is to focus on existing MRs and achieve the installed base of 200 TULSA-PRO sites. At the same time, we are in the final stages of achieving compatibility for the new Siemens Interventional MR, the Free.Max. We believe that as early as later in 2026, TULSA plus sites with the Free.Max plus TULSA-PRO will be operational, opening the door to the future and interventional MR suite with TULSA. These sites will further streamline the patient and staffing workflow, making it easier to further drive adoption. We continue to get confirmation that hospitals that are being paid for all qualified Medicare patients and that they are satisfied with the amount received. In addition, many commercial payers are also now covering the procedure on a case-by-case basis. And we are excited by the recent upgrading of our AI-powered software to include simpler patient workflow for patients who suffer from BPH symptoms. Having the flexibility to safely, effectively and efficiently treat a variety of patients with prostate cancer and now with BPH, gives our sites the flexibility to stack cases, creating a full TULSA Procedure day, which leads to efficiency and easier scheduling for the hospital staff. It also significantly expands our TAM. And the economics associated with real-time iMRI procedures, in prostate cancer, like MR in-bore biopsy and TULSA are becoming increasingly compelling. Before my closing remarks, I would like to take a few minutes to talk about our second large opportunity, Sonalleve. This technology, which is currently offered primarily as a onetime capital sale uses same MR imaging and thermographic technology, as TULSA-PRO and combines that with focused ultrasound from outside the body delivers -- delivered via a disk to treat disease. There are currently 10 Sonalleve devices operational in parts of Europe, China and Southeast Asia, where over 4,000 women have already been treated with the technology for adenomyosis and uterine fibroid diseases of the uterus that can cause chronic pain and heavy and/or prolonged menstruation. Treatment with Sonalleve has demonstrated pain and symptom relief without affecting the ovarian reserve and with reports of women preserving their fertility. Sonalleve is also now being used in research and clinical trials in Europe for the ablation of pancreatic cancer tissue and other oncological disease. We are working on an FDA regulatory strategy for the technology and a potential new recurring revenue opportunity on top of the initial capital sale for the device. And we'll provide more details on our progress later this year. To summarize, Profound is pioneering iMRI procedures, which enable precise incision-free therapies that improve clinical confidence, procedural control, and patient outcomes. By leveraging real-time MR guidance, Profound technology -- the technologies are designed to replace uncertainty with clarity across treatment planning, delivery and confirmation. We're the only company that has the technology to kill tissue from the inside of the body, via a catheter that is placed via a natural orifice, which is our TULSA technology, or from the outside via a disc, which is the Sonalleve technology. In either product configuration, MR is used to image and measure temperature in real time and enable cell kill with a minimum energy requirement. Our sales team is clearly delivering, and the pipeline as we define is now growing over 110 as compared to 97 at the end of 2025. TULSA-PRO install base was at 78 at year-end, and we expect that to reach approximately 120 by end of 2026. The new AI volume reduction module to treat patients with BPH symptoms is significantly reducing the procedure time, making it very competitive with other BPH treatment technologies. This application has the potential to add 400,000 patients to our annual TAM essentially tripling our previous TAM. Having the BPH module also enables physicians to create a full TULSA day during which both their prostate cancer and/or BPH patients are treated. From the perspective of the ease of scheduling and creating a vibrant TULSA program, this ability is particularly important. Our second technology platform, Sonalleve is poised to start becoming a more core part of our story in the coming months and quarter, both internationally and in the United States. And finally, we believe that on the basis of the many catalysts we see ahead, we can reach high double-digit to low triple-digit revenue growth. This ends our prepared remarks for today. With that, we're happy to take any questions you might have. Operator?

[Operator Instructions] Our first question will come from the line of Ben Haynor with Lake Street Capital Markets.

First one for me on the private payers, I appreciate the commentary on giving commercial insurers to pay for it, you think in the second half of the year. I was wondering if you can give us any sense of what your customers are seeing now. I know I think on the Q3 call, you mentioned that commercial insurers were reimbursing roughly $25,000 to $65,000 is the range you had seen. And then any commentary on whether you're being successful in getting any commercial rejections overturned ultimately?

Ben, yes. So the number of patients who are going through the private is increasing. The typical payments are between -- I would say, most of them are between 1.5x to 2.5x of Medicare. So we're pretty satisfied and our sites are happy with the numbers. With respect to coverage and reversals from rejections were tracking better than 90% at this point. Just recently, I saw one very strategic reversal. There are certain independent organizations in the U.S. like Maximus and so on. These companies actually make independent determinations that hospitals use as guides or whether or not a new technology is considered experimental or standard of care, and they recently deemed our TULSA as standard of care. So we're pretty optimistic actually. We're very, very satisfied with the numbers that we're seeing, and we are very optimistic we'll start to see actually converting these reductions into coverage decisions in the second half this year.

That's very helpful. Great. And then I apologize if I missed this, but can you maybe comment here on the dynamics of the sequential decline you saw in noncapital revenue here?

We lost you a little bit. Could you repeat the question?

Yes. I was wonder -- I apologize if I missed this, but could you maybe comment on the dynamics that you saw in terms of utilization? It looks like there was a sequential decline in noncapital revenue here from Q3 to Q4.

[Technical Difficulty]

Could you comment on the dynamics of utilization from Q3 to Q4 and whether the movement in noncapital revenue sequentially?

Yes. Yes. Got it. Okay. Yes. No, I think the number of -- I think the trend that we have talked about is pretty much every site is slowly but surely increasing usage. And I think last quarter we had a specific number that quarter-over-quarter we were up about 20-plus percent. I think that trend continues in terms of procedures. I think as Tom talked about also a little bit in his presentation that I think this year, with the new catalysts, I think the CAPTAIN data coming out next Friday, the BPH module now being distributed to our customers, I think that certainly we expect that the rate of usage will increase at a faster pace in 2026. With respect to your question, if you're asking about the dynamics on the capital. I think, we are still in the early innings and capital is harder to predict than recurring revenue is for sure. And we did give a couple of market introductory prices to a couple of sites. In Q4, as Rashed mentioned, and I think at the moment, you will see the ratio of capital versus recurring in our total product mix is going to become a little bit more capital heavy, because we are selling the devices now. And as Tom mentioned, the pipeline is pretty strong. But over the long haul, I think that, we remain primarily a recurring revenue company. Over 70% of our revenue ultimately will come from recurring revenue. But in the next couple of years as we build the installed base, I think you'll see that ratio to be closer to -- it will range between 40% to 60% capital per quarter.

Okay. Got it. And then just talking about the installs for this year and looking at for 40-or-so more units, and that's roughly 1/3 of the pipeline that you have. Are there any bottlenecks on year-end that need to be taken care of in terms of the capacity to install new units? Is there anything that you can improve on your side of things?

Ben, we are a growing company. So most certainly, Q4 was a very dynamic quarter. And because we shipped for the first time systems in double digits. And yes, we are increasing our logistics and operations side, we're actually looking to put a warehouse in the U.S. that would allow us to streamline some of the shipments. We are also putting all the ERP systems to make sure all the scheduling and building of the devices are taking place. Nothing that is anything out of the ordinary that we would not do at this time in our company. But yes, there is a lot of dynamics along the lines of making sure that, as Tom and his team starts to build the top line that we are able to deliver appropriately.

Our next question comes from the line of John McAulay with Stifel.

I want to put a finer point on the recurring revenue question that's been asked. So just as I do the back of the envelope math here, if procedures grew roughly 20% quarter-over-quarter, as you said, total recurring revenue, $2.3 million, it implies that revenue per procedure declined significantly, something like more than 50% quarter-over-quarter. So I just want to understand how much of this is driven by the more capital-focused mix? Was there some kind of onetime conversion or discounting in here? And what should we expect go-forward on a revenue per procedure basis?

Yes. So John, first of all, the 20% was year-over-year, not quarter-over-quarter. So when I say that -- yes, year-over-year. And we do look at inventory. And so we do sort of manage it a little bit. So I think when you see recurring revenue quarter-over-quarter, it does not necessarily reflect almost exactly through the usage of the product. And we do kind of manage that a little bit. Generally, actually, they will buy in the third quarter to use it in the fourth quarter. So you see that a little bit of up and down like that. So I would not directly correlate, but if you look at 6 months over 6 months, I think it will be relevant instead of quarter -- each quarter. There was no discounting at all. Our price for disposables is $5,500 fixed. And the sites that do not own the equipment is very few at this point. But in those cases, we do have higher number than $5,500. So there is absolutely no discounting on the disposable price.

Understood. That's helpful. And switching gears to 2026, you talked about high double-digit, low triple digit growth. Consensus is currently, I think it's something like 120%. Our numbers closer to 100%. Where do you hope we end up in this range? I mean if I try to read between the lines here and I assume a range of 90% to 110%, not with specific numbers, it seems like 100% might be a median, but maybe you could just help us out on where you would hope estimates end up for the year ahead.

Yes. So when we did not particularly provide official guidance on revenue at the moment, we certainly feel very confident in terms of the number of sites. And I think if your analysis though is in the right ballpark, in the sense that we're looking at, at least 42 sites this year, which we have provided. And if you look at the math that Tom provided in his presentation, I think you add up all of those, you're sort of going to end up with the range that you just described.

Understood. That's helpful. And I could just sneak in one more question. You talked about the dynamic of recurring versus capital mix in the future, and you still believe in that 70-30 longer-term range, but in this year ahead, I mean I'm just looking at the fourth quarter results, I mean, the mix was something closer to 40% recurring, 60% capital, roughly. I mean is that the sort of mix we should be thinking about for 2026?

I think so. John, I think that the number of sites is going to increase, and you can see if we're adding 42 sites that $0.5 million, you can see the number is going to be dominating. So I would say, at least -- on average, I would say, at least for the first few years, 50-50 or 60-40 is probably reasonable. But I want to sort of -- don't want to lose sight for the fact that we are primarily a recurring revenue company. And I think we went through a lot of detail today on purpose because it helps you see how TULSA is positioned against everybody. And you can hopefully see how confident we are about our positioning. And so part of the reason for that confidence is that when we see TULSA being placed, our devices are being used and the use is definitely increasing. And so I think that long term, that 70-30 mix is a very reasonable thing to expect.

Our next question will come from the line of Michael Freeman with Raymond James.

I'm going to ask a question on the CAPTAIN trial. It's exciting that you've decided to disseminate information on the trial next week. Can you go over the -- I guess, the decision-making process for releasing this data early. Was -- does getting an early look at this trial compromise the trial at all. Does it remain a Level 1 trial? And then following up on -- as a follow-up question, do you expect the early dissemination of this data to potentially accelerate reimbursement time lines for private payers?

So yes, thank you. That's -- those are important questions actually. So let me answer your second question first. I do expect that the earlier data will suddenly gives us more confidence in getting coverage decisions this year. But to your first question, a little bit more technical. We are very careful, as you know, on making sure that our data when we present that our trials are pristine, and then with proper analysis and guidance from leading physicians. So as we looked at this, and it just happened in the last couple of days, as we looked at all this, those precedents and typically used and the reality is that 6-month data actually is a very important milestone data set. In fact, particularly for urinary incontinence, and it's used routinely in BPH trial, for example. And we have, as Mathieu described, there is sufficient data already out on the robotic prostatectomy arm with respect to margins, so which is a sort of indicator of the success of early treatment or not. So there's we're not presenting any data that will be considered out of the ordinary here. These are standard endpoints, and they are measured in a way that are very credible. So we are not going to compromise anything. We are running the company. We certainly execute every day, but we are running the company with a very strategic mindset. So we're absolutely not going to compromise anything. But having said that, I think you will see meaningful standard data that will be credible.

Okay. All right. I wonder there was some discussion in the remarks about progress towards cash flow positivity. I wonder if you could provide a threshold, whether that's scale or time line to when you expect Profound to be -- to have reached cash flow positivity?

Yes. So I can -- if you look at the data that we have been publishing and if you look at, for example, the first half of this year, our cash burn was just over $10 million, each quarter. If you look at third quarter, our cash burn was about $8 million. If you look at -- if you analyze the data in the fourth quarter, you will see the cash burn is down to around 6 -- a little bit above -- a little less than $6.5 million. So I think you can start to see the trend already and it is matching with the increase in the revenue. And again, they won't be perfect. It will be -- in some quarters, you'll see a little bit up or down because we are adding people and maybe they're not going to be completely synchronized. But I think the reason we are comfortable and confident and presented it because I think we can start to see the trend. And I think if you project your numbers, what as Tom mentioned, the end point is we think that we can be profitable in the range of $80 million to $85 million revenues. So you can see where we are in about $24 million, $25 million revenues with the cash plan, you can see the $80 million, $85 million. And I think with the growth rates that you can probably predict from the installed base, and it's just expectation, I think you'll be able to get pretty close.

Okay. All right. I'm going to squeeze a quick one in. You provided good guardrails on TULSA install expectations for the year. I guess, more granularly looking at the first quarter as we're well progressed. Wondering if you could provide some commentary on, I guess, the pacing of those installations through the year and how first quarter is proceeded.

I'm sorry, I couldn't hear everything you said. If you could please repeat it?

Sure. I was looking for some color on TULSA installation progress during the first quarter. And also how we might expect pacing of those procedures through the year, given your expectations that you provided earlier in the call.

Oh, I see. What you mean -- so you're looking for granularity quarter-over-quarter basis?

That's right.

So we're trying to get to a standardized way of announcing numbers, and we think more standardized is end of this quarter. So which is why we were at 78. We are higher than that today, for sure than we were at the time. But I would say, again, I think generally speaking, med tech companies growths are generally in the second half of the quarter. So I would say if you're modeling, I would model it sort of increasing quarter-over-quarter and not linearly every quarter.

[Operator Instructions] Our next question will come from the line of Scott McAuley with Paradigm Capital.

Already been covered, but maybe I could just ask on the BPH module. Any granularity on how many of the installations are currently using it?

Good question, actually. I would say there are at least 10 sites that have already started using it. In terms of the forecast, I think the numbers are increasing pretty rapidly, I would say, by midyear, we will have at least 30, 40 sites using it.

That's great. And there was a few announcements around international expansions and agreements. And I think in the margin discussion, there was a comment on some kind of introductory pricing, I believe, maybe for international, but I may have misread that. Any kind of progress on the international front for TULSA?

Yes. Very good question, Scott. So in the second half of last year, we also started to get quite a bit of attention in the international markets. And historically, we've always talked about U.S. being are really, really the only focus. And U.S., most certainly is 90% of our focus today. But we felt that it was important that, in fact, the healthcare world is far more global than it might look. So getting incoming calls and getting opinion leaders in international markets, not serving them did not make sense. And so what Tom and the team have done is we've signed up with a number of distributors, the couple that he mentioned. And the discounts were only to those new distributors to get them going. But there was no discounting in the U.S., and we don't expect discounting in the future, which is why Rashed was very confident that the 70-plus percent margin that we've maintained for the year and for most of other quarters that, that is very much intact. So our strategy in the international market is still very careful, but it is through distributors. And we will have support people and high-level senior people who will manage the distributors, but we don't plan to grow a direct sales team in the international market. That is only for the U.S. But we're seeing, for sure, very good interest in number of -- I think Europe is going to be slow until there is reimbursement decisions in Europe. But I think the Asian markets are definitely very strong.

That's great. And down the road, as that international kind of presence and impact grows, is that something you're going to separate out a bit more in terms of U.S. installations versus global installations and revenue relative to each of those areas.

Yes. Over time, we will. Once they become material, we will.

Just one clarification. We do break out the international revenue. So there is a segment reporting, that's where we do break out revenue source where is it coming from.

Yes, yes, definitely. I think it was more the international revenue specific to TULSA, but as it becomes more meaningful down the road, maybe be more specific around that.

Our next question comes from the line of Chris Potter with Northern Border Investments.

Just on the utilization question. From your customers' perspective, can you just talk about how many procedures per site they're looking for in terms of it making economic sense for them. In other words, I think if I'm doing the math right, each of your sites is doing 20 or 25 procedures a year now, which didn't sound like a whole lot. You gave the example of having 200 systems doing 50 procedures a year, is 50 procedures a year kind of the ideal for your typical customer? Or is it higher than that? I would think it would be higher than that.

Yes. So at the moment, a number of these sites are very new. And so the sites that we installed in Q4 virtually is non-existent in terms of the utilization. So I think just that math of taking the whole installed base and that is probably, I would say, take 60% of the installed base and use that would give you a better number. Having said that, I think your key question, we think 50 is a very reasonable number. We have sites today that are doing well over 100. We do have some research sites that acquired the system early on that we're doing maybe 10 procedures per year and now that there's reimbursement there. These are large hospitals that are slow moving, but they are very slow moving here. But they are all looking to finally increase. And again, as reimbursement, particularly from private insurance companies kick in, they're going to start increasing as well. So I think to answer your question, do we think that the ultimate number is going to be better than 50? We do. But at the moment, since we are below 50, we think 50 is a good average target to hit. And 200 sites is not a very big number. We think we can achieve that also. And so I think over the long haul, I can certainly tell you if we hit average of 50, we're not going to be -- we're going to be a bit disappointed. But I think, particularly, as I was talking about in the prepared remarks, I think as they start establishing TULSA day with the ability to then treat whole-gland and partial-gland and BPH altogether, there's enough patient volume now with this model that I think 50 is a very achievable number.

That's helpful. Would you expect that the average utilization per site would increase materially in 2026?

I think in the second half of '26, I do believe that, yes. One of the things that Tom has talked about is that as we update our sales design and we described it a little bit for you. We are starting to put -- to go to the much more of a hunter/farmer model where the farmers are -- is a team that we're building that will pay attention to utilization more than before. Historically, because we've not had reimbursement, it's not been a big thing, but we've moved our genius team in the commercial organization. We're building a sales team that is a farmer-based team. I think that team together will drive better startup for these new sites, and better utilization over time.

And I'm showing no further questions at this time. And I would like to hand the conference back over to Dr. Menawat for closing remarks.

Thank you so much for spending the time with us. We really appreciate the attention. We are excited about where we're going, and we look forward to updating you at the end of Q1. Have a good evening.

This concludes today's conference call. Thank you for participating, and you may all disconnect. Everyone, have a great day.