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"}}},"operationIndicators":{"details":{"anesthesia":"local","days_in_clinic":1,"days_in_country":3,"rehabilitation_days":1,"satisfied_percent":78,"treatment_duration_hours":1},"illness_kind_details":{"requests_processed":46119}},"responsibleDoctor":{"id":290,"alias":"yesim-yildirim","name":"Yesim Yildirim","photo":"doctor/699da18e34fa6","advisory_text":"20 años de experiencia Oncólogo médico, certificado ESMO","linkedin":"","specialities":[{"id":"onc.001","name":"Oncólogo clínico","illness_kind_id":10}]},"direction":{"id":10,"name":"Oncología","alias":"oncology"},"illness_kind":{"id":10,"name":{"en":"Oncology"}},"parsed_details":{"procedure_type":"therapy","fields":{"anesthesia":["regional"],"back_to_work_days":{"min":2,"max":7,"unit":"days","qualifier":"Desk work sooner; depends on urinary symptoms and job physical demands."},"complication_rate_pct":{"min":10,"max":30,"unit":"percent","qualifier":"Grade 2 or higher urinary, bowel or sexual toxicity; urinary retention 5-10%; serious grade 3+ under 5%."},"contraindications":["Cannot tolerate anesthesia or applicator placement for the chosen site","Tumour extent or geometry unsuitable for localized implant","Pregnancy","Prior radiation to same area with limited tissue tolerance (relative)","Active local infection or uncorrected bleeding disorder (relative)"],"days_in_clinic":{"min":0,"max":0,"unit":"nights","qualifier":"Typical LDR prostate seed implant is same-day discharge after recovery from spinal anesthesia."},"diagnostic_duration_minutes":null,"diagnostic_preparation":null,"diagnostic_referral_needed":null,"diagnostic_result_time_hours":null,"exercise_resume_weeks":{"min":1,"max":2,"unit":"weeks","qualifier":"Light activity first; strenuous exercise depends on perineal soreness and urinary symptoms."},"final_result_months":{"min":24,"max":36,"unit":"months","qualifier":"PSA nadir often reached 2-3 years as seeds decay; response judged by PSA trend."},"fly_home_after_days":{"min":2,"max":5,"unit":"days","qualifier":"Depends on urinary retention risk, catheter need, and radiation oncologist clearance."},"follow_up_visits":[{"purpose":"wound_check","after":{"min":7,"max":14,"unit":"days","qualifier":"Check of urinary symptoms and perineal site; often done remotely for international patients."},"requirement":"conditional"},{"purpose":"assessment","after":{"min":28,"max":35,"unit":"days","qualifier":"Post-implant CT dosimetry to confirm seed position and dose coverage."},"requirement":"routine"},{"purpose":"result_review","after":{"min":90,"max":180,"unit":"days","qualifier":"First PSA check and symptom review, then repeated PSA testing every 6 months."},"requirement":"routine"}],"indications":["Localized prostate cancer: LDR alone (low/intermediate risk) or EBRT boost","Cervical and endometrial cancer, usually combined with external beam radiotherapy","Breast cancer (accelerated partial breast irradiation in selected patients)","Selected skin, esophageal, endobronchial, head and neck, rectal, soft-tissue tumours"],"main_risks":["Urinary symptoms, urinary retention, and bowel irritation after prostate brachytherapy","Erectile dysfunction after prostate brachytherapy (may develop gradually)","Vaginal stenosis, cystitis, proctitis, or fistula after gynecologic brachytherapy","Local pain, bruising, swelling, or infection at the implant site","Anesthesia-related risks where anesthesia is used","Late fibrosis or tissue damage in irradiated areas","Applicator or seed displacement or migration","Small risk of secondary malignancy over the long term"],"pain":"Mild to moderate perineal soreness and bruising for several days, usually controlled with simple analgesics. Urinary burning and urgency may last weeks.","preparation":["Staging MRI and biopsy review","Prostate volume study by ultrasound","Stop blood thinners as advised","Fasting before anesthesia","Bowel preparation or enema before procedure","Urinary medication such as alpha-blocker","Plan radiation-safety precautions for travel"],"recovery_timeline":[{"phase":"Day of implant","description":"Seeds placed through the perineum under ultrasound guidance; discharge after recovery from anesthesia, sometimes with a catheter.","restrictions":["No driving after anesthesia","Rest for the day"]},{"phase":"Days 1-7","description":"Perineal soreness, bruising, and urinary frequency or burning are common; return to light activity.","restrictions":["Avoid heavy lifting","Avoid prolonged sitting on hard surfaces","Keep distance from children and pregnant women as advised"]},{"phase":"Weeks 2-12","description":"Urinary and bowel irritation peak then gradually settle as seeds deliver dose.","restrictions":["Use condoms for first ejaculations as advised","Avoid strenuous exercise until symptoms ease"]},{"phase":"Months 3-36","description":"Seeds decay; symptoms resolve and PSA falls to its lowest level.","restrictions":[]}],"rehabilitation_days":{"min":3,"max":7,"unit":"days","qualifier":"Time to ordinary daily function; urinary symptoms may persist longer without limiting activity."},"result_longevity":"Permanent seeds treat the tumour once; cancer control is long-term, with durable biochemical control in most low-risk patients beyond 10 years.","revision_rate_pct":{"min":2,"max":10,"unit":"percent","qualifier":"Salvage or repeat treatment for local recurrence, or procedures for urinary obstruction, within about 10 years."},"scars":"No surgical scar; only tiny needle puncture marks in the perineum that heal within days.","sessions_or_stages":{"sessions":{"min":1,"max":1,"unit":"visits","qualifier":"Single seed implantation procedure."},"stages":[{"code":"planning","label":"Prostate volume study and dose planning","after":{"min":0,"max":0,"unit":"days","qualifier":"Done before or on the day of implant."}},{"code":"implant","label":"Permanent seed implantation","after":{"min":0,"max":0,"unit":"days","qualifier":"Single procedure."}},{"code":"dosimetry","label":"Post-implant CT dose verification","after":{"min":28,"max":35,"unit":"days","qualifier":"Confirms seed position after swelling resolves."}}],"qualifier":"Standalone LDR prostate monotherapy with one implant."},"success":{"metric":"Biochemical relapse-free survival after LDR prostate brachytherapy","value":90,"unit":"percent","horizon":"5 years","population":"Adults with low- to intermediate-risk localized prostate cancer treated with LDR monotherapy","evidence_status":"limited"},"techniques":[{"name":"Low-dose-rate (LDR) permanent seed implantation","suits_whom":"Mainly selected localized prostate cancer patients, and some other small localized tumours","recovery":"Seeds stay in place and decay over months; temporary radiation-safety precautions may apply."},{"name":"High-dose-rate (HDR) temporary afterloading brachytherapy","suits_whom":"Gynecologic, prostate (boost or monotherapy), breast, esophageal, endobronchial, and skin or soft-tissue tumours","recovery":"Sources are inserted for minutes and then removed. Recovery depends on site and applicator type."},{"name":"Intracavitary or surface (mould or applicator) brachytherapy","suits_whom":"Cervical or endometrial cancer (intracavitary) and selected superficial skin lesions","recovery":"Usually short, with site-specific mucosal or skin reactions."}],"treatment_conditions":["day_case"],"treatment_duration_hours":{"min":1,"max":2,"unit":"hours","qualifier":"Procedure time for seed placement; longer with anesthesia and recovery."},"initial_assessment_documents":["Biopsy pathology report","Staging MRI or CT scans and reports","Oncologist treatment summary","Prior radiotherapy records (if available)","PSA test results"],"travel_trips":{"min":1,"max":2,"one_trip_possible":true,"qualifier":"LDR seeds and HDR monotherapy: one stay, days to 2 weeks; HDR with external radiotherapy may need 2 trips."},"clinic_checks":{"status":"ok","items":[{"id":"C1","text":"Check you will have a consultation with the Clinical Oncologist before treatment, where the 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will be taken and you may need to attend a Pre-Op assessment in the same visit.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"F3","text":"Clinic staff cannot communicate fluently with you in your own language","scope":"treatment_abroad","source":{"url":"https://wwwnc.cdc.gov/travel/page/medical-tourism","host":"wwwnc.cdc.gov","quote":"Receiving care at a facility where you do not speak the language fluently could lead to misunderstandings about your care.","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}}],"checked_at":"2026-11-13","next_check_at":"2027-11-13","version":1},"warning_signs":{"status":"ok","items":[{"id":"W1","text":"Trouble breathing or swallowing","urgency":"emergency","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/16500-brachytherapy","host":"my.clevelandclinic.org","quote":"Trouble breathing or swallowing","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W2","text":"Severe stomach upset, vomiting or diarrhea","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/16500-brachytherapy","host":"my.clevelandclinic.org","quote":"Severe stomach upset, vomiting or diarrhea","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W3","text":"Difficulty peeing or stopping pee from leaking","urgency":"contact_clinic","general":false,"source":{"url":"https://my.clevelandclinic.org/health/treatments/16500-brachytherapy","host":"my.clevelandclinic.org","quote":"Difficulty peeing or stopping pee from leaking","tier":"tier1_medical","fetched_at":"2026-11-13","http_status":200}},{"id":"W4","text":"Difficulty controlling when you 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