<p>Cognitive-behavioral stress management (CBSM), which integrates active coping strategies, has been shown to enhance psychological adaptation in cancer survivors, resulting in reduced emotional distress and better quality of life. However, research on the impact of active coping in advanced cancer survivorship remains underexplored. This study examined whether active coping mediated the effects of CBSM on perceived stress among men with advanced prostate cancer (APC). APC survivors (N = 189) who had received androgen deprivation therapy (ADT) were randomized to a 10-week CBSM or a health promotion (HP) intervention and followed for one year. Structural equation modeling was used to test whether active coping mediated the effect of CBSM on perceived stress adjusting for relevant sociodemographic and clinical covariates, and to determine whether this mediating role was specific to the CBSM condition. CBSM predicted a decrease in perceived stress from baseline to 12&#xa0;months post-baseline through active coping. As expected, this full mediating effect was observed only in patients who received CBSM. While active coping declined over time, CBSM appeared to have a buffer effect, helping to sustain coping compared to the control group. This may be particularly relevant for advanced cancer survivors, who often experience a general shift towards less coping over time, potentially due to psychological adaptation and increasing physical burdens. Findings suggest that sustaining active coping mechanisms through CBSM can contribute to reducing psychological stress and improving health-related quality of life in APC survivors. Future research should focus on optimizing interventions by tailoring coping strategies to the evolving needs of this population.</p>