Purpose <p>Prostate cancer is one of the most prevalent cancers worldwide. Active surveillance is a widely accepted treatment option for some localised prostate cancers. However, concerns have been raised about the experiences of men on this treatment given that almost 40% will discontinue without clinical indications. The objective of this review was to identify the lived experience of men on active surveillance.</p> Methods <p>A systematic review and meta-synthesis, according to PRISMA guidelines. Studies were included if they reported qualitative data exploring the experiences of men undertaking active surveillance. Thomas and Harden’s approach was undertaken for data synthesis.</p> Results <p>Five databases were searched identifying 3226 articles, and 13 studies met the inclusion criteria. Two overarching analytical themes were identified: (i) men on active surveillance live with a lack of certainty; and (ii) re-establishing agency drives resilience and facilitates confidence in active surveillance. Lack of certainty on active surveillance is derived from men feeling a loss of control over their health and/or lives. This induces a stress response of ongoing worry and anxiety and loss of agency, further driving the stress cycle. Re-establishing agency alleviates the stress response, promotes resilience, and facilitates confidence in active surveillance.</p> Conclusions <p>The experience of active surveillance is underpinned by ongoing lack of certainty diminishing agency and driving cyclical stress.</p> Implications for Cancer Survivors <p>It is essential that health professionals better support men to establish and maintain confidence in active surveillance. Further research into men’s perspectives of interventions and strategies that best facilitate agency and effectively support them is warranted.</p>