 [ Symptoms ] i am a fair skin afro american male and i have hyperpigmentation on my neck and arms what can be the cause of this [ Disease ] ok there are a number of different factors that play into whether this prostate cancer is going to be significant obviously we want to know the volume of the cancer is there a lot there obviously the more there is the worse it is and we want to know the grain how aggressive it is is this like a little puppy or is it like a doberman with rabies the more aggressive the cancer the worse the prognosis the more likely you will need aggressive therapy and the larger volume also has a role and we also do studies to evaluate has it spread is it just in one little area or has it spread so that is the two factors that we look at in determining how aggressive this cancer will or will not be for you then we have to look at the factors that relate to you what is your health what is your age how old were your parents when they died if not if your father died at age 50 and you are 47 then    sl ok we will go back to that so um if your father is 50 years old when he died and you are 47 then we may not be as aggressive with higher risk treatments if on the other hand you are 57 and your father is 94 and still active vibrant healthy then we need to consider that you probably have 40 years ahead of you and we will be more aggressive we also need to look at your health if you have any heart disease blood vessel disease diabetes if you are out climbing mountains and hiking the grand canyon and you are 63 then we are going to want to be more aggressive as well so all of those factors go into determining the nature of what the threat is because we never want the treatment worse than the disease we know that for the majority of men prostate cancer will not kill them so we want to customize treatment if you are young and healthy we may be more aggressive if you are old and have health problems we probably will not