Active surveillance is a preferred strategy for patients with low-risk prostate cancer to delay and/or avoid side effects of treatment. While its impact on health-related quality of life (HRQOL) has been studied, factors influencing follow-up adherence and patient involvement in active surveillance protocols remain less understood. This study aimed to explore patient perspectives on testing modalities, frequencies, and satisfaction with active surveillance. HRQOL surveys and active surveillance-specific questions assessed patients undergoing active surveillance at a US academic medical center between 2019 and 2021 after Institutional Review Board approval. Respondents were invited to interviews and thematic analysis identified key themes. Forty-six participants completed surveys and 12 were interviewed. Satisfaction with active surveillance was reported by 93.3%, and 97.7% indicated a willingness to opt for the same treatment again. Anxiety and urinary function were key factors influencing quality of life. Trust in the doctor's recommendations, avoiding side effects, and feeling it is a good way to monitor their cancer were common reasons for choosing active surveillance. Addressing organizational factors, treatment equity, and evolving patient perspectives can refine active surveillance protocols. Understanding patient experiences can inform tailored protocols and improve patient-provider communication, enhancing patients' well-being and adherence.