Active surveillance (AS) as treatment option for prostate cancer (PCa) has been systematically offered from Vestfold Hospital Trust since 2009. This option proposes delay or avoidance of radical treatment and its troublesome side effects especially urinary leakage and erectile dysfunction. The aim is to compare urinary problems, sexual dysfunction and health‐related quality of life (HRQOL) between Norwegian PCa patients undergoing radical retropubic prostatectomy (RRP) and AS. A cross‐sectional study of 330 PCa patients diagnosed between 2010 and 2014 at Vestfold Hospital Trust was performed, including 150 in an AS group and 180 in a RRP group. HRQOL was assessed using the SF‐12 questionnaire. Sexual and urinary function was assessed through excerpts from The Expanded Prostate Cancer Index‐50 Question (EPIC‐50). Continuous data was analysed with t‐tests, while categorical data was analysed with χ2‐tests. In addition, linear regression analysis was performed. No difference in HRQOL was observed between the two groups despite significant differences in urinary leakage and sexual function. The AS group had a significantly lower proportion of men with a Physical Component Score (PCS) ≤ 40. We did not find the same pattern for Mental Component Score (MCS). The difference in PCS was not significant after adjustment for treatment, age, relationship and other independent variables. The findings are important for nurses informing PCa patients eligible for AS. The majority of men adjust with their disease and report good HRQOL, despite urinary leakage and erectile dysfunction after RRP compared with nontreated men on AS.