Aim of Work: The aim of the current essay is to closely review the role of brachytherapy in localized prostate cancer with special interest in its rationale, patient selection, different techniques of application and provide data about treatment outcome with comparison to external beam radiation and other modalities used. Results of Literature: Since not all treatment approaches are suitable for all patients, brachytherapy seems as an attractive option. It is appealing to older patients that are not physically able to withstand a complicated prostatectomy, as well as for younger men that wish to maintain a normal life-style. This approach would reduce health care costs and medical personnel workload, and it would likely improve patient comfort and convenience.Treatment outcome results of brachytherapy are comparable to that of other methods; whether used as monotherapy in low risk prostate cancer where 5 year biochemical relapse free rates range from 93-96%, or as combination therapy for intermediate and high risk disease, with 5 year relapse free survival ranging from 70-90% and 48-89%, respectively, with post implantation studies showing superior outcome with improved target coverage by implants. Although radiobiological data suggests that dose rate is an important factor in treatment, clinical evidence shows no difference in tumor control rates between high and low dose rate brachytherapy.With regards to toxicity brachytherapy has shown varying results. Gastrointestinal side effects were less than that experienced with EBRT, especially with intraoperative planning technique, with the isotope used determining the onset and duration of radiation proctitis (103Pd producing more rapid onset and resolution). However, urinary toxicity seems to be equal to or higher than with EBRT and the incidence of acute urinary retention has decreased with improved patient selection criteria, technique and experience. Conclusion: Brachytherapy produces an outcome comparable to that of other treatment modalities used in localized prostate cancer, nowadays especially with the advent of computer-based planning and improvement of implantation Recent technological advances in HDR brachytherapy increased the appeal and application of this approach for both patient and practitioner. With the availability of dose distribution optimization, monotherapy dose escalation studies with adequate extraprostatic disease coverage are being assessed by ongoing clinical studies for higher risk prostate cancer.