We found a lack of reliable evidence for effects of brachytherapy in men with localised non-metastatic prostate cancer. Particular difficulties exist in this therapeutic area, since the treatments are still evolving and may be used in many different combinations. Long follow up is required to determine mortality, because of the slow natural history of this disease. We found a large number of small case series, a small number of cohort studies and no randomised controlled trials. Valid comparisons between brachytherapy and other treatments such as watchful waiting, radical prostatectomy, external radiotherapy or anti-androgen drug regimens are not possible based on existing studies. There may be subsets of men who respond better to treatment that includes brachytherapy compared to management without brachytherapy. However, randomised controlled trials with long follow up for clinically important outcomes and adequate description of therapeutic techniques are required to support this conclusion.