Background: Male lower urinary tract symptoms (LUTS) have been correlated with an increased risk of death, however it is unclear if LUTS treatment will reduce this risk. Objective: To determine whether a reduction in LUTS is associated with a reduced risk of mortality. Design, setting, and participants: Secondary analysis of the Medical Treatment of Prostate Symptoms (MTOPS) randomised trial in which men were randomised to placebo, doxazosin, finasteride, or doxazosin and finasteride. Men were recruited from multiple centers in the United States between 1993-1998. Those >50 years of age with moderate to severe LUTS on the AUASS were included. Outcome measure & statistical analysis: Primary outcome was death. We used an extended cox model and adjusted it for age and treatment assignment; hazard ratios (HR) with 95% confidence intervals are reported. Results: A total of 3046 men were randomised and had a baseline AUASS. The mean age was 62.6 (SD7.3), the mean baseline AUASS was 17.1 (SD6.0) and the mean follow-up period was 6.1 (SD 1.2) years. For each 1-point improvement in the AUASS, the HR for death was 0.96 (0.94-0.99, p=0.01), independent of treatment group assignment. A comparable significant reduction in death was seen with 1-point improvements in the storage (HR 0.94, 95%CI 0.88-0.99, p=0.04) and voiding (HR 0.95, 95%CI 0.91-0.99, p=0.03) subscales individually. Conclusions: Improvement in male LUTS was associated with a reduced risk of death. Further study is warranted to determine if the male LUTS treatment paradigm should shift towards symptom treatment independent of bother. Patient summary: Men with moderate or severe urinary symptoms that had an improvement in their symptoms had a lower risk of death. This has potential implications for how urinary symptoms are viewed, and when treatment should be offered.