Purpose of review Active surveillance is emerging as a serious alternative to radical therapy for low-risk prostate cancer. In a situation in which the difference in effects on disease morbidity and mortality of different treatment options for these malignancies is likely to be small, the quality of life and psychological aspects may be decisive in treatment choice. Recent findings The following three are the main issues being covered in the literature on psychological aspects of active surveillance. First, the process of consultation with the physician and treatment choice in men diagnosed with low-risk prostate cancer. Second, the effect of active surveillance on physical domains and resulting anxiety and distress, and on quality of life in general. And third, the possible supportive and educational interventions for patients on active surveillance. Observations are scar Summary At the moment of treatment choice, fear of disease progression is the main reason to reject active surveillance. Active surveillance may spare physical domains and does not cause much anxiety or distress on short term in men who choose this strategy. Once men opt for active surveillance, only a minority of them switch to radical treatment due to psychological reasons. Supportive and educational interventions should be considered.