The Prostate Cancer Institute of America was founded in 2022 by Ajay Bhatnagar, MD, and has since grown into a national network collaborating with ASCs to deliver low-dose rate brachytherapy (also known as radioactive seed therapy) to patients.
Becker’s recently spoke with PCIA co-founder Manuj Agarwal, MD, about the network’s trajectory. He discussed PCIA’s origin story, what’s on the horizon, and his advice for leaders in the ASC space looking to build and scale their own networks.
Editor’s note: Responses have been lightly edited for length and clarity.
Question: When you and Dr. Bhatnagar decided to launch PCIA, what were the critical unmet needs you identified and how did those shape the network’s foundational governance and early operating model?
Dr. Manuj Agarwal: The idea for PCIA started with a simple observation. Prostate brachytherapy was a proven curative, minimally invasive therapy that was being underutilized across the country. And it wasn’t because patients didn’t want it. It was because there were too few skilled interventional radiation oncologists, and most practices and hospitals and health systems have shifted toward more expensive, prolonged forms of external radiation.
My partner and I have trained with some of the pioneers in the field, and we saw firsthand how effective brachytherapy could be, and we knew that there was a way to bring this back to the community setting, closer to where patients live without compromised quality. So we built PCIA around physician-led turnkey models that empower urologists and ASC partners to perform these procedures under their own roof, with our clinical technical and compliance infrastructure around them.
In the beginning, it was really about proving the concept, showing that this highly specialized therapy could be safely delivered in the ASC environment. And the first challenge was navigating, step by step, regulations and logistics around radioactive materials, staffing, creating standardized protocols, radiation safety, training, so that any site could replicate our outcomes. Success really came when partners realized that they could not only expand access for their patients, but strengthen their independence by owning that service line rather than referring it out.
Since then, we’ve grown into a national network, collaborating with urologists, health systems, ASCs across the country. But the beauty here is that every site remains local and clinically led, and that’s the key to maintaining quality and autonomy.
Q: As PCIA has grown, what have been the most significant obstacles — and how have you mitigated them?
MA: Some of the challenges have been scaling. Gatekeepers to prostate cancer are urologists, who help navigate that patient through the ecosystem. I would say our greatest partners have been the ASC operators and owners themselves, because they see the value in what we bring. The procedure itself is super quick. We perform this procedure in under an hour, and it’s very lucrative for both the performing urologists and for the technical revenues outstanding.
The biggest barrier has been getting people to the table to realize this, and getting enough stakeholders involved who can have these patients navigate to the ASC setting.
Q: Looking ahead, what “next‑horizon” opportunities do you see for PCIA over the next three to five years?
MA: We’re focused on selective growth. In addition to what we do for whole-gland prostate brachytherapy, there are opportunities for focal therapy. There are opportunities for patients who have cancer recurrence after primary radiation therapy. Unfortunately, that can happen fairly often.
But what it comes down to is efficiency within the ASCs. We all can understand how important it is to have throughput, but with these cases being reimbursed fairly well, it does become a volume game. Supporting our partners with training and operations, and turning these ASCs into centers of excellence for prostate cancer is a completely new model that most ASCs have not really jumped into.
We’re looking at new geographies. Right now, most of our business is in the southwest, and we’re expanding on the East Coast and leveraging our data to show how this model improves access, outcomes, and cost of care. Ultimately, it comes down to taking the best care of patients. Our long-term vision is to make PCIA synonymous with excellence and precision with cancer treatment nationwide.
Q: What advice would you give to ASC leaders who want to build and scale their own network?
MA: Start with the right partners, people who share your standards, your integrity, not just your spreadsheets. Things look great on paper, but a lot of times, these programs dissipate because you’re not aligned. So, build the right systems before you scale. Have the right protocols and compliance training. And above all, if you keep physicians in the driver’s seat, that’s a winning formula.
