Dear Dr. Roach: I'm 67 and male. When I had a male doctor, he did a yearly testicle and prostate exam during my physical. Now the practice has been taken over by female doctors, and for the past three years, this has not been done.

Is this new? Is there a correct way to ask why the change?


Dear Anon.: There has indeed been a change in the way prostate and testicular screening tests have been considered in recent years, and recommendations by advisory groups have changed, as well. The current recommendation by the most influential group in the U.S., the Preventive Services Task Force, is against routine screening for prostate cancer and testicular cancer. However, there are some situations, such as with a strong family history, in which screening for these conditions is appropriate, and it is always appropriate for your doctor to listen to your concerns.

As far as male doctors versus female, most studies have shown women physicians tend to spend more time with their patients and tend to be more in compliance with practice guidelines. However, differences between individuals are more important than differences between the groups. Just tell your doctor, male or female, that you would like to further discuss prostate and testicular cancer screening.

Dear Dr. Roach: I know you're not a psychiatrist, but I hope you can help. My dad was a single parent raising us kids, and he was always clean when it came to housework. Rooms in our house were almost spotless.

But lately, we have noticed him becoming a hoarder and being more disorganized. He keeps weeks-old newspapers everywhere, and he gets upset if we try to help him clean. He's 79. Could it be a sign of senility or Alzheimer's?


Dear R.S.: Hoarding can have several psychiatric causes, and, indeed, a psychiatrist may be necessary to make the diagnosis. However, odds are that your dad always had some form of obsessive-compulsive disorder, and with age has become worse.

There are other possibilities. Fronto-temporal dementia, a type of dementia that is distinct from Alzheimer's disease, has a variant in which personality and behavior changes are prominent, but given the history of what sounds like unusual cleanliness habits, I would suspect that OCD is the most likely diagnosis. There usually is a long delay from the time symptoms begin until the time the diagnosis is made. A diagnosis needs to be made before treatment — be it medications, psychotherapy or some combination — can begin. Treatment can improve not only the hoarding behavior but also the distress your dad is feeling. A psychiatrist or psychologist is the expert in making the diagnosis and for treatment.

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