This review of the literature on late rectal complications after prostate brachytherapy indicated that it is a highly effective treatment modality for patients with clinically localized prostate cancer but can cause chronic radiation proctitis. The most common manifestation of chronic radiation proctitis was anterior rectal wall bleeding, which often occurred within the first 2 years after brachytherapy. It is interesting to note that the rates of late rectal morbidity appear to have declined over time, which may reflect improvements in implantation techniques and imaging. Rectal biopsy as part of the workup to evaluate rectal bleeding can lead to rectal fistula and the need for colostomy, a rare but major complication. The authors recommend 1) screening colonoscopy before brachytherapy for patients who have not had a screening colonoscopy within the preceding 3 years to rule out colorectal malignancies and, thus, facilitate conservative management should rectal bleeding occur; 2) lifestyle modifications during treatment to limit exposure of the rectum to radiation; and 3) conservative management for rectal bleeding that occurs within 2 years after brachytherapy. Prostate cancer is the leading cause of cancer in men and accounts for approximately 33% of cancer deaths among men in the US.1,2 Management options for organ-confined, low-to intermediate-risk prostate cancer include watchful waiting, radical prostatectomy, external-beam radiation therapy, and prostate brachytherapy with permanent interstitial implants. Recent improvements in radioactive seed implantation techniques have established prostate brachytherapy as a highly effective treatment modality for localized prostate cancer, with long-term local and biochemical control similar to outcomes observed after radical prostatectomy and external-beam radiation therapy. 3,4 Because prostate cancer is diagnosed