more than 50% acyclovir bioavailability, a 3 to &fold increase for the pro-drug compared to peroral administration of the parent compound. In this study patients were instructed to self-initiate treatment of the study drug within 24 hours of the first symptoms or signs of herpes recurrence. Compared to placebo, valaciclovir administered twice daily within 24 hours of onset of an episode accelerated the time to episode resolution and lesion healing. In addition, valaciclovir treatment increased the frequency of aborted lesions and decreased symptom duration. Pain and discomfort as well as viral shedding were reduced, and there were no identifiable adverse reactions. The combination of these benefits as well as a more convenient twice daily dose should prompt the consideration of valaciclovir for episodic treatment of recurrent herpes genitalis. Anthony J. Schaeffer, M.D.
BOOK REVIEWS Comprehensive Textbook of Genitourinary Oncology N. J. VOGELZANG, P. T. SCARDINO, W. U. SHIPLEY AND D. S. COFFEY, Baltimore: Williams & Wilkins, 1,151 pages, 1996 Comprehensive Textbook of Genitourinary Oncology is one of the first successful attempts a t combining recent advances in molecular biology with the clinical practice of genitourinary oncology. As the title states, this textbook is comprehensive in scope and it provides the reader with a n in-depth reference to all aspects of the diagnosis and management of genitourinary oncology. The editors, each recognized for their contributions in the fields of medical oncology, genitourinary surgery, radiation oncology and molecular biology, have assembled an international group of contributors with expertise in their assigned chapter subject. This textbook is well written and edited. It addresses epidemiological findings and those at the molecular level, and allows equal presentation of controversial alternatives for managing genitourinary malignancy. This first edition is divided into 7 sections: 1)overview of urological oncology, 2 ) pediatric tumors, 3) adrenal and kidney cancers, 4) transitional cell carcinomas of the urinary tract, 5) prostate cancer, 6) testis cancer and 7) rare urological malignancies for a total of 68 chapters. Overall each chapter is clearly focused on 1 particular topic in genitourinary oncology or treatment strategy and it provides the reader with an excellent resource of references. The first section covers 3 aspects of urological oncology that have not been addressed in detail in previous textbooks. The chapter on measuring cancer therapy outcome provides practical information for interpreting results of clinical trials, although some biostatistical language and equations are not easily understood. This chapter finishes with 2 excellent reviews analyzing health related quality of life and decision analysis. These areas are becoming increasingly important, since clinicians must understand the impact of different treatment strategies on patients, especially men with prostate cancer. The second chapter deals with important issues, such as cancer patient advocacy, pain control, hospice care and nutritional support, which become more vital as therapy prolongs survival of patients with cancer. The third chapter provides a clear discussion of the molecular changes of different genitourinary malignancies with an emphasis on prostate cancer. This review sets the stage for more detailed discussions that are provided later on molecular biology as it relates t o kidney, bladder, prostate and testis neoplasms. Each of the chapters in this textbook on molecular genetics and molecular carcinogenesis provides an excellent overview of the latest developments for understanding the relationship of the cancer cell to its environment as well as some mutational events that contribute to the initiation and progression of cancer. The chapter on the molecular genetics of renal cell carcinoma highlights an important work in genitourinary oncology: identification of the von Hippel-Lindau tumor suppressor gene by linkage analysis. In addition, a clear discussion is provided on the genetic analysis of sporadic renal cell carcinoma, and some growth factors and oncogenes that may regulate cell growth and proliferation. The chapter on biochemical and molecular carcinogenesis of bladder cancer emphasizes the importance of arylamines, which are constituents of cigarette smoke, in the etiology of transitional cell carcinoma and the activation mechanisms of this bladder carcinogen. This discussion is directed more toward the scientist and not the clinician trying to understand the basics of molecular alterations of bladder cancer. The following chapter on the molecular biology of bladder cancer is more easily understood by the clinician. This chapter is an excellent discussion of the chromosomal alterations and mutational changes in bladder carcinogenesis, such as those involving the p53 and retinoblastoma genes, and it provides a diagram to illustrate 2 genetic pathways of progression from the normal mothelium to invasive disease. Chapters on the molecular genetics of prostate cancer similarly give the reader some insight into alterations, such as tumor suppressor gene mutations, deoxyribonucleic acid methylation and e-cadherin loss, which may be involved in disease progression. In addition, we are given a glimpse of hereditary prostate cancer and an overview of some inherited cancer susceptibility
genes. Overall these chapters on molecular genetics achieve the dual goals of providing current information and references for the scientist interested in genitourinary malignancies and the clinician seeking to understand basic concepts. Until important clinical trials decipher the role of these abnormal genes in tumor initiation and progression, a multidisciplinary approach, including medical, surgical and radiation oncology, remains the mainstay of treatment for genitourinary malignancy. A wide range of management strategies are presented for each genitourinary malignancy. Excellent reviews are provided on less common genitourinary neoplasms, including Wilms tumor, pediatric and adult sarcomas, neuroblastoma, penile and urethral tumors, and malignant lymphomas of the genitourinary tract. These chapters discuss the diagnosis, staging and latest developments in therapy of these more uncommon tumors that may not be as familiar to the clinician. The chapter on the surgical management of localized renal cell carcinoma gives the reader an extensive overview of the indications for nephron sparing surgery, including the controversy on partial nephrectomy with a normal contralateral kidney. The section on resection of tumor with inferior vena caval extension is detailed and complete, and it may be used as a reference for residents in training. The chapter on the management of superficial bladder cancer addresses all alternatives in treatment with intravesical chemotherapy and immunotherapy, including treatment with interferon and bropirimine. The results of radical cystectomy for bladder cancer are presented in detail for each pathological stage and the chapter addresses the controversial issue of cystectomy for recurrent or high grade superficial disease. The chapter on bladder preserving treatments is equally comprehensive. However, the authors argue against neobladder construction. They state that neobladders can only be created in 10%of patients and they are not indicated in female patients. This statement is in contrast to the conclusions of a recent international consensus conference on bladder cancer that the continent urinary reservoir has evolved into the diversion of choice at most centers around the world that treat patients with bladder cancer who require cystectomy. In addition, several reports have recently appeared in the literature detailing successful outcomes with urethral neobladders in women. Chapters on the management of prostate cancer are comprehensive, leaving no stone unturned. There is an excellent review of prostatic intraepithelial neoplasia and an elegant description with clear illustrations of the technique of radical prostatectomy. Special attention should be paid to the description of securing the dorsal vein complex and preparation of the urethra. The section on testis cancer is equally complete, providing the reader with clear discussions on carcinoma in situ of the testis, retroperitoneal lymph node dissection for low stage and residual disease following chemotherapy, surveillance versus chemotherapy for low stage tumors and relevant chemotherapeutic protocols for advanced disease, including an overview of autologous marrow transplants. Comprehensive Textbook of Genitourinary Oncology is an excellent addition to previous textbooks dealing with the diagnosis and management of genitourinary neoplasms. It provides the reader with an excellent resource for answering important therapeutic questions and those related to molecular advances in the field of genitourinary oncology. This book is not a surgical atlas and, therefore, there is no uniformity in surgical illustrations or the extent to which authors provide surgical detail. The editors have certainly achieved their 3 goals with this textbook: 1) it is easily read by academic and nonacademic physicians, 2) it is a reference for the basic scientist working in the field of genitourinary malignancies and 3) it provides a clear description of this diverse set of neoplasms for residents in training. David Esrig, M.D. Section of Urology Yale Uniuersity School of Medicine New Haven, Connecticut Imaging of the Scrotum: Textbook and Atlas
H. HRICAK, B. HAMM AND B. KIM, New York: Raven Press, 262 pages, 1995 This volume, the work of 12 authors, including the 3 editors, is divided into 2 components: a traditional textbook followed by a self-examination atlas. While addressing scrotal applications of magnetic resonance imaging (MRI1, computerized tomography (CT), nuclear medicine and angiography, both components appropriately emphasize ultrasound as the primary imaging tool for the scrotum. The textbook begins with brief chapters reviewing scrotal anatomy and embryology, and clinical examination of the scrotum. Subsequently technical aspects of ultrasound, CT, MRI, nuclear medicine and angiography with specific clinical applications of each modality are reviewed. Chapters dealing with the clinical and imaging features of congenital disorders, testicular tumors and tumor-like conditions, acute scrotum and extratesticular scrotal structures make up the bulk of the textbook. Discussions are comprehensive and they reflect the state of the art in most areas. Illustrations are generally excellent. A helpful feature is the diagram that accompanies each image, depicting the orientation of each image with respect to the scrotudtestes. Correlative photographs of pathological specimens add to the value of the images. The atlas displays images related to 130 cases in a way that allows the reader to test hisher ability to interpret the image. For each case an abbreviated history and physical examination findings are presented prior to discussion of imaging findings and the clinicaVpathologica1 diagnosis. Although so111c cases are redundant, the combination of cases is reasonable in t e r n s of what is encountered in practice. 'Tile rnajority of cases involve sonograms but MRI, CT and radionuclide studies are included. The use of pulsed/color