1004 BOOK REVIEWS

Although this distinctly British volumethoroughly describes the confusion, the authorsare powerless to dispel the multitude of controver-sies about the prostate. Sixteen authors contribute234 pages in updating everything about the pros-tate from the normal anatomy to the immunologicmechanisms in prostatic cancer. Of the 16 chap-ters, 11 are 12 pages or fewer in length includingthe bibliographies, most of which are currentthrough 1983. Among other US contributors,McGuire (on urodynamics), Fair (on prostatitis),Kaufman (on incontinence after prostatectomy),and Catalona (on immunology) add immensely tothe overall quality with succinctly organized sub-ject reviews.

Perhaps because ofthe delay in publication, thecurrent resurgence of interest in radical prostatec-tomy for localized disease essentially has beenignored. Fully 16 pages are devoted to radiother-apy. Not only is no chapter allotted to radicalprostatectomy, this subject is scarcely mentioned.When survival probabilities for patients treatedby radical prostatectomy have consistently out-distanced survival associated with all other typesof therapy, it is difficult to understand how thistreatment modality could be so casually neglected.Only Bruce and Mahan clearly state that "radicalsurgery remains the treatment of choice in alimited number of patients with low grade, local-ized disease." Chisholm, in making the case forobservation when disease is localized to onelobe, and Lytton, in calling "radiation treat-ment ... probably as effective as radical prostatec-tomy," set an exceptional bias for treatment oflocalized cancer. Because of the heterogeneousnature of the malignant prostatic cell population,it is not surprising that single-modality therapywith irradiation alone or endocrine therapy aloneoften fails to cure. In contrast, when disease istruly localized, a radical surgical procedure can beexpected to remove the entire malignant cell popu-lation. With maintenance of potency by nervepreservation and achievement of total continencewith careful dissection, patients may look forwardto full rehabilitation and minimal infringementon the quality of life after radical prostatectomy.

Chisholm's excellent chapter on the naturalhistory of prostatic cancer begins with vintageWhitmore ideas. (Whitmore1 contributed one ofthe classic articles on the subject and, for somereason, has not been cited.) With death rates from

Mayo Clin Proe, December 1986, Vol 61

prostatic cancer essentially constant from decadeto decade, there is "the possibility that treatmentis an incidental event in an inexorable naturalhistory of the tumor," a sobering thought for all ofus urologists on soapboxes claiming the "best"treatment in our individual experiences.

Of special note is the superb chapter by Peelingand colleagues on the clinical staging of prostaticcancer. Ultrasound images are "top-flight." Noimaging procedures, however, have yet achievedperfection to the point that they can be accepted asa fully useful adjunct in day-to-day clinical prac-tice in terms of both cost-effectiveness and highcorrelation between the site of imaged "carci-noma" and the histologic site and extent of thecancer.

In summary, I enjoyed this new contribution notbecause I agreed with what was said or how it wassaid (at times I did not) but because I liked beingforced to think about what was said and how itwas said. In this book, Blandy and Lytton editedinformation of interest to anyone in the medicalprofession, from the student to the emeritus pro-fessor of urology. The best prose is found inchapters by Blandy and by Peeling. The concept ofthe prostate as "croissant-shaped" has to delightanyone's imagination.

Robert P. Myers, M.D.Department of Urology

REFERENCE1. Whitmore WF Jr: The natural history of prostatic cancer.

Cancer 32:1104-1112,1973

Women Physicians in Leadership Roles,edited by Leah J. Dickstein and Carol C. Nadel-son, 333 pp, with illus, $18.50, Washington, DC,American Psychiatric Press, 1986

The recent increase of women in medicine hasbeen phenomenal. Nevertheless, women are under-represented in administration and in other lead-ership positions. This book examines the pastand present status of women practicing medicine,with a primary focus on women in psychiatry.Included in this volume are 35 articles edited bytwo respected women in the field of psychiatry,Leah J. Dickstein, M.D., and Carol C. Nadelson,

Mayo CUD Proe, December 1986, Vol 61

M.D. (the first woman president of the AmericanPsychiatric Association). The editors' goal was toshow that women are competent and are ready tobe leaders despite diverse leadership styles. Ibelieve that they accomplished this goal, and Istrongly encourage other women to read thisunique book.

The book is divided into nine sections. Sectionsone and two present historical perspectives ofwomen in medicine and of women in psychiatry.One article in the first section contrasts past andpresent problems faced by women. Earlier in thecentury, problems revolved around the issues ofthe competence of women to practice medicine andwhether being a woman and being a physicianwere even compatible. Current challenges forwomen include dealing with subtle discrimina-tions, slow promotion of women in academicmedicine, and the need for more attention to begiven to women's health-care issues. Section threecompiles biographies of eight women who areuniversally accepted as early leaders in the field ofpsychiatry. This section is the most readable andfor many readers will be the most enjoyable. Ittraces each individual's career development andalso describes the personal struggles and supportsof each woman. Thus, the reader can identify withthe problems, emotions, and capabilities of thesewomen who were able to overcome many obstaclesto gain recognition in their field.

In sections four and five, personal and profes-sional accounts are presented by contemporarywomen in leadership roles. Section six looks atpresent-day issues that may account for the under-representation of female leaders in medicineand in other professions. It contains an interest-ing article on transference and countertransfer-ence that delineates problems that can stem fromfeelings toward women in positions of authorityand from feelings that women sometimes bring totheir jobs. Section seven highlights female psychi-atrists in academia; section eight briefly describesexperiences of women practicing medicine in Can-ada and Australia, and section nine focuses onwomen in medical politics.

Despite multiple authorship, the material hasminimal repetition, but the writing skill varies.The effort to present the leaders as human beingswas successful and consistent. There were moresimilarities than differences in the women de-scribed; a common concern was integration of

BOOK REVIEWS 1005

family life with professional practice. Although Iwas obligated to read the book, I thoroughlyenjoyed it, and I can easily recommend it to others.The most obvious readership will be other femalepsychiatrists; however, much of the material willbe of interest to female physicians practicing inother specialties as well. Because of the biographicsketches, historical data, and focus on leadership,selected articles may also appeal to other profes-sional women and men.

Joyce A. Tinsley, M.D.Department of Psychiatry

and Psychology

Computers in Medicine: Applications andPossibilities, by Jonathan Javitt, 317 pp, withillus, Philadelphia, W. B. Saunders Company,1986

For those readers interested in the contributionsthat computers can make to the field of medicine,this book is an excellent source of information.Material was contributed by 14 authors, 11 ofwhom are medical doctors and 1 of whom is amedical student. Thus, the book has a definitemedical orientation.

The book is divided into two parts: (1)computersas tools for personal productivity and (2) clinicalapplications of computers in medical care.

In the first part, the information is well orga-nized and could apply to almost any field. Thereader will need no prior exposure to computers tounderstand the concepts presented. The contro-versy between the mainframe computer and themicrocomputer is explored, and the benefits andinadequacies of each system are honestly dis-cussed. The basic software tools of word-processing programs, electronic spreadsheets,and data bases are discussed with attention to usein the office environment and to special featuresthat are available and advantageous. The subjectof telecommunications for internal office use orforremote access to office material is addressed,including the topic of electronic security of patientdata. Commercially available data bases forbibliographic data searches of the medical litera-ture are described, as are the on-line medicalservices currently available.