Permanent interstitial brachytherapy with I-125 or Pd-103 seeds is a well-established approach as single modality for low-risk prostate cancer patients and as part of a multi-modality program for intermediate- and high-risk patients. There are multiple approaches that have been developed to deliver high-quality implants, including pre-planned and real-time intra-operative techniques. In the hands of experienced users, either approach can provide consistently excellent outcomes. We believe that the combination of real-time intra-operative dosimetry and connected seeds may provide for improved consistency due to decreased seed migration.