The best treatment option for patients with prostate cancer who experience local relapse after external beam radiation therapy remains uncertain. Salvage brachytherapy, cryotherapy, HIFU and radical prostatectomy have shown varying biochemical and quality-of-life outcomes according to disease-related and patient-related factors, but follow-up data are still short. It seems clear that careful patient selection for salvage brachytherapy is essential for good clinical and quality-of-life outcomes. We present a review of the currently available experiences of brachytherapy as salvage treatment after failure to external beam radiotherapy.