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Nicolette Krebitz Oliver Broumis Mark Waschke Robert Hunger-Bühler. Paul Faßnacht. Corinna Kirchhoff Wolfgang Böck. Robert Schupp. muzhchin/muzhskaja-odezhda/verhnjaja-odezhda-2/kurtki-2/kurtka-s-oliver-2/ 2 1 % cosminpopan.co+ruedi 1 %. Bertschy Olivier, lic. iur. von Känel Daniela, lic. iur. Otto Oliver, lic. iur. Meili Conny Bühler Marc Jenni Daniel Schröder Thomas 70 45

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Wirtschaft Stv. Leiterin Abt. Cinnamon may suppress inflammatory disease. Curcumin, the yellow pigment of turmeric, as well as capsaicin in chilli pepper, are reported [48] to have cancerrestraining activity.

Others exercise a range of biological actions, such as the inhibition of angiogenesis or promotion of apoptosis [50, 51].

An inhibitory effect on various experimental tumours was reported 40 Keith Griffiths et al. Flavonoids have a 2-phenylchroman nucleus, and isoflavonoids such as genistein have a 3-phenylchroman nucleus.

Also illustrated are the structures of resveratrol, a constituent of red wine, and one of the catechins present in tea [54, 55], together with an ability to promote apoptosis in prostate cancer cell lines [56].

A recent study [57] indicated that men with a high long-term intake of selenium, as reflected in toenail paring levels, were at lower risk of developing prostate cancer.

More recently [58] a decreased incidence of prostate cancer was reported after selenium supplementation. More than 30, North American males are to be recruited, minimal age generally 55, but 50 for African-Americans, valuable therefore, in determining whether they effectively restrain progression to clinical cancer.

Vitamins Much of the epidemiological data relating to the cancer protective value of vitamin supplementation would seem somewhat equivocal.

Conversely, another review [61] of data on vitamins A, C and E, concluded that the association between vitamin C and breast cancer risk was limited, although a modest, protective effect of vitamin A was recognised.

Boyle [63, 64] emphasised caution in accepting conclusions derived from such studies, outlining the need for controlled trials before, for example, vitamin supplementation should be recommended as protective against breast cancer.

The data Fig. Vitamin E had no effect on lung cancer risk. Recent interest has centred on lycopene Fig. Uncooked tomatoes are a less effective source.

Lycopene is another effective anti-oxidant [66, 67], with a recent analysis of anti-oxidants in biopsies of adipose tissue showing [68] it to be the principal constituent.

It restrains the growth of cultured cancer cells [69], possibly by inhibition of IGF-signalling networks [70]. Tomato powder, as distinct from purified lycopene, increased prostate cancer-specific survival, in N-methyl-N-nitrosourea-treated rats [71].

Giovannucci [72] considers that tomato intake 42 Keith Griffiths et al. Illustrated are the numbers of cases of prostate cancer, also seen in relation to the incidence values for cancers of lung and bladder consistently relates to a reduced risk of prostate cancer, which is inversely associated with plasma lycopene concentrations.

The influence of the carotenoids, vitamin A, retinoids and retinoic acid on prostate carcinogenesis would seem complex.

Although vitamin A supports normal cellular differentiation and controls proliferation, it has a limited influence on established cancer.

Various synthetic retinoid analogues have similar characteristics, and despite high toxicity are thought by some to offer anti-cancer properties [73].

Although it seems that vitamin A supplementation may increase the risk of prostate cancer [63, 64], Schroeder [76] reported a significant increased risk associated with a lower serum vitamin A levels.

Possibly relevant are the classical experiments of Lasnitski [77, 78], which demonstrated that methylcholanthrene-induced prostate epithelial hyperplasia was inhibited by retinoic acid as well as vitamin A.

Results of a chemopreventive study [71] of lycopene are also shown. The levels of 1,diOH-VitD3 in stored serum from these men were compared to controls, matched for age, race and for sample storage time.

Noteworthy, however, was that risk was associated only with palpable tumours, not incidental cancer, suggesting that any influence is confined to the later stages of tumour progression.

The skin, the only source of vitamin D3, is where 7-dehydrocholesterol is converted by solar UV irradiation to the provitamin D3.

Thermal isomerisation of provitamin D3 to vitamin D3, occurs in the epidermis from where it enters the blood. It is hydroxylated at the C position in the liver and then, primarily in the kidney but also by keratinocytes, hydroxylated to 1,diOH-VitD3, the biologically active hormone, the biological effects of which are mediated [96] through VDR.

VDR is associated with enhanced apoptosis, increased expression of Bcl-2 and G1S cell cycle blockade in prostate cancer cell lines.

In the USA, prostate cancer mortality is inversely proportional to UV-radiation [99], and in Finland, vitamin D deficiency similarly relates to UV-radiation and cancer.

Levels of plasma OH-VitD3, which have been falling during the past 25 years as prostate cancer incidence has increased, are markedly different between men in the rural north during winter than in the southern region.

The risk that relates to vitamin D deficiency is higher in pre-andropausal men than those over 50, suggesting a risk factor which implicates androgens.

Also illustrated are some effects of retinoic acid on the proliferation of various prostate cell lines in culture. Retinoic acid did not restrain the growth of the human prostate cancer cell lines PC3 and DU Data taken from the Tenovus Institute for Cancer Research [90] Hormonal Aspects of Prevention Prevention with dietary factors offers an exciting prospect, but an anti-hormonal approach is more pragmatic.

Such males did, however, develop acceptable secondary sex characteristics, reasonable libido and a phallus, characteristics promoted by testosterone.

The use of anti-androgens such as flutamide, bicalutamide or cyproterone acetate could offer benefit to men at high risk, but loss of potency, gynaecomastia, nausea and diarrhoea, are unwanted adverse features.

Quite rightly, trials have 46 been instigated [34, 35], although anti-androgen therapy cannot be perceived as an acceptable preventive approach to recommend, for example, to all African-American males over the age of 40, men who must by now believe themselves at risk.

The development of finasteride [, ], a 5AR inhibitor, provided an innovative approach to suppressing intraprostatic DHT levels without compromising sexuality.

Finasteride specifically inhibits 5AR2, whereas alternatives, dutasteride and epristeride, inhibit both 5AR1 and The Prostate Cancer Prevention Trial PCPT involved treating patients for 7 years with either finasteride 5 mg daily or placebo, followed by an end-point prostate biopsy.

Plasma testosterone levels are sustained. Rather than biopsy and its confounding problems, some believe the only acceptable end-points should be survival, metastasis-free survival or disease-specific survival, which is an expensive approach requiring more subjects and longer periods of study, but one that could possibly offer unequivocal results.

Second, there is the question as to whether such a trial should commence at an earlier age than Such issues have been considered recently [].

However, the greater prevalence of high-grade cancer in the finasteride group, with a Gleason score of 7 or more, tends to compromise any unequivocal recommendation regarding the clinical value of finasteride in preventive practise for men over The NCI-P trial, which is evaluating flutamide against the combination of flutamide and the anti-oestrogen toremifene, offers a new approach to preventive therapy.

Since oestrogens play a more significant role in prostate growth regulatory events than hitherto thought [7, 9, 27], the influence of an anti-oestrogen is awaited with interest.

Is There a Genetic Approach to Prevention Recognising the long preclinical phase in the natural history of prostate cancer, the identification of men with a genetic predisposition to develop the disease would clearly be beneficial.

Familial clustering [] and evidence that family history constitutes a greater risk suggests underlying predisposing factors.

The search centred on point mutations, deletion or insertion of nucleotides within a gene sequence that result in aberrant messenger m RNA expression and thereby mutant proteins.

Decreased repeats from 24 to 18 relate to elevated AR transactivation activity and prostate cancer [, ], with the prevalence of shorter alleles highest in African-Americans and lowest in Asian men, reflecting the geographical variation in incidence.

Mutant ARs that inappropriately bind an array of ligands [] would seem rare in early prostate cancer, although prevalent in metastatic tissue.

Gene amplification, whereby substantial lengths of nucleotide sequences are copied, sometimes more than a fold, is a common feature of cancer.

If the sequence contains genes encoding for growth regulatory proteins, the effect could support cancer progression.

Gene deletion incurs cellular instability and restricted growth restraint; the loss of growth suppressor retinoblastoma Rb protein, for example, inevitably confers a growth advantage to the cancer cell.

Loss of a p53 gene, which encodes the protein that prevents a damaged cell entering the cell cycle until DNA repair is complete, is 4 The Prevention of Prostate Cancer generally an event related to the later refractory phases of the disease.

Many low-penetrance susceptibility genes, mapped to frequently deleted regions in prostate cancers, are concerned with androgen metabolism.

Genetic aberration of the SRD5A2 gene would influence the prostate, and mutations have been reported, with VL89 reducing enzyme activity, which is common in Asian men, whereas A49T relates to increased activity and poor prognosis [].

The latter mis-sense mutation is associated with a sevenfold greater risk of prostate cancer in African-American men. Aberrations of the HSD17B2 gene, 16q Gene polymorphisms may identify men at risk, but also support the design of preventive strategies with shorter time-periods and lower costs.

Dietary Factors: Causative or Protective? Some Reflections on Obesity and Fat Intake Possibly of significance is that prostate cancer geographical variability is reflected in a similar pattern for cancers of breast, ovary and endometrium, for which oestrogens are risk factors.

Sound arguments support some degree of homology between breast and prostate cancers [27, ], and evidence has accumulated to suggest a major role for oestrogens in prostate growth control [9, 27, ].

Once again, geographical variability in incidence directs attention to Asian and Western lifestyles, issues outlined by Doll [] three decades ago, since when, after many retrospective and prospective investigations, the consensus viewpoint of three cancer agencies [] was, very simply, that the consumption of vegetables and fruit correlates with reduced risk.

The greater risk associated with red meat, primarily beef, thereby allowed governmental institutions to recommend frequent consumption of vegetables and fruit, with moderation in meat intake.

Broad recommendations, therefore, with the International Agency for Research on Cancer IARC suggest [] that there is little support, at present, for various supplementary cocktails of vitamins and minerals, although the results of the SELECT trial are eagerly anticipated.

The influence of dietary fat on cancer risk remains controversial. Some researchers have not been convinced [] that eating a low-fat diet supports a longer life.

Nonetheless, with greater fat intake in Japan, prostate cancer incidence increases [33]; whether this relates to a decreased consumption of soy protein, however, remains to be determined.

A range of prospective cohort studies on total dietary fat intake and prostate cancer risk [] failed to identify an unequivocal relationship, although a correlation with animal fat intake was recognised, a relationship believed by many to constitute the principal risk factor responsible for geographical variability.

Important, nonetheless, was that obesity did relate to a greater risk of dying from prostate cancer.

Any link between risk and obesity, or increased body mass index BMI , does, however, remain controversial []. Whereas a Norwegian study [] suggested a higher BMI increased risk, Giovannucci [] indicated the contrary.

Treatment with an aromatase inhibitor is of clinical value in the management of breast cancer; interestingly, enterolactone, genistein and equol all inhibit the aromatase enzyme in vitro [9, ].

Possibly more important is the relationship of risk to obesity during puberty and the immediate post-pubertal years, with a report [] that adolescent obesity increased the risk of dying from prostate cancer.

Such a lifestyle would lead to elevated levels of androgens and IGF-I. Since the IGFnetwork supports proliferation and the progression of cells into the cell cycle Fig.

Prostate Cancer: A Multifactorial Process Prostate carcinogenesis is a multi-step process involving multiple interactive factors and endocrine, genetic and nutritional features that impact on growth regulatory events [6] that either support or restrain cancer progression through the continuum from initiation to the invasive phenotype.

Interruption of these events is the basis of prevention. Such a strategy using antihormonal drugs is clearly an important issue.

DHT is a predominant growth-promoting factor in prostate cancer development, and the PCPT trial provided evidence of a beneficial influence of finasteride therapy for part of a group of men treated beyond the age of A controversial issue centres on whether the decline in intraprostatic DHT triggers a compensatory expression of alternative, more aggressive growth-promoting signalling in the more progressive cancerous lesions that will be harboured by a proportion of such males, with the consequent development of high-grade cancer.

There is evidence that chronic, or recurrent intraprostatic inflammation, a feature of asymptomatic prostatitis and PIA, could be implicated in the early phases of prostate carcinogenesis [24, 25, 27].

Moreover, a study by Coffey [27], emphasising a role for isoflavonoids in the suppression of prostatic inflammation induced in rodents by inappropriate intrauterine oestrogen imprinting, highlights the need for trials of soy protein supplementation during the adolescent and post-pubertal years.

Certainly at the andropause, the phyto-oestrogens may well suppress progression of latent cancer to malignant disease, and trials with soy protein would seem appropriate.

Furthermore, soy protein supplements, as opposed to genistein alone, may be relevant, since it appears that only certain males can convert daidzein to equol Fig.

There is evidence that the presentation of a higher-grade prostate cancer is associated with an ability to produce equol.

Moreover, infusion of green tea leaves with hot water liberates secoisolariciresinol and matairesinol, precursors of enterolactone.

The proanthocyanidins are more effective antioxidants than vitamins C and E, whereas resveratrol has anti-inflammatory properties and influences ER-signalling.

Statins, tocotrienols and limonene inhibit HMG-reductase. The mevalonic acid 6C-unit is the basic starter molecule of the cholesterol biosynthetic pathway, being converted first to the 5C-isopentyl pyrophosphate through two farnesyl units to lanosterol and then cholesterol study [] provides evidence that they inhibit the progression of HGPIN to clinical cancer.

A recent case control study in south-eastern China [] reports a significant correlation between green tea consumption and the risk of prostate cancer.

There is evidence [] that the tea polyphenols inhibit prostate cancer dissemination by repressing the PSA-triggered activation of matrix metalloproteinases that are concerned with fibronectin and laminin degradation and thereby support cancer cell invasion.

In passing, there is a notion [] that alcohol itself may promote the aromatisation of androgens. The isothiocyanates of cruciferous vegetables, constituents such as sulphoraphane, could also exercise some degree of protection against prostate cancer initiation, possessing the capacity to detoxify particular animal carcinogens such as the heterocyclic aromatic amines produced by the charring of red meat [27, ].

This is somewhat controversial, since risk appears to relate to the intake of red meat [10], despite such amines 4 The Prevention of Prostate Cancer 51 Fig.

Nevertheless, sulphoraphane promotes apoptosis, decreases cyclin B1 expression and induces G2M cell cycle arrest in human prostate cancer cell lines.

Although cancer was simply considered an imbalance between cell proliferation and cell death, more recently, failure of cancer cells to undergo apoptosis has become the major issue [, ].

There is no doubt that the statins decrease serum cholesterol and benefit those with cardiovascular problems, but can they decrease cancer risk?

HMGCoA reductase inhibition will suppress the synthesis of isoprenoid residues, thereby inhibiting isoprenylation of the p21 Ras protein, important for Ras GTP-ase signalling.

Isoprenyl- ation involves the transfer of either Cfarnesyl, or Cgeranylgeranyl isoprene residues to the pprotein, thereby increasing its lipophobic nature that enables GTPase to be anchored, then re-located within the cell membrane.

Ras mutations are a feature of prostate cancer, and repression of isoprenylation of the mutated p21 Ras protein provides growth control.

Transfection of this mutated protein into mouse fibroblasts in the presence of insulin and IGF-I results in transformation and enhanced cell proliferation.

Also interesting is that prenylflavonoids [] such as isopentenyl-naringenin act as oestrogen agonists. The less well known tocotrienols, natural analogues of tocopherol Fig.

Although the precise role of oestrogens within the prostate remains somewhat of a conundrum, they consistently feature in preventive strategies; indolecarbinol, for example, a constituent of cruciferous vegetables such as cabbage, cauliflower, Brussels sprouts and broccoli, influences the metabolism of 2- and hydroxylated oestrogens.

Indolecarbinol is a product of cruciferous vegetables. The indolecarbinol can prevent genotoxic agents from reaching their target site and, second, induce 2-hydroxylase enzyme systems Bradlow [] reports that hydroxylation relates to cancer initiation, whereas 2-hydroxylation is associated with suppression.

Indole-3carbinol induces the 2-hydroxylases Fig. They can be quite distinct, sometimes complementary, but often mutually antagonistic, with differing affinities with various oestrogens [37, 39], and prostate carcinogenesis will be influenced by the cellular specificity and content of ER-isoforms.

Can ge- 4 The Prevention of Prostate Cancer nistein suppress AR levels and thereby epithelial cell proliferation during the early male adult years?

Should year-olds undertake soy protein supplementation? Scientifically credible preventive measures must be inextricably linked to curative medicine, based on a precise understanding of the natural history of a disease.

Second, preventive strategies must be integrated into community screening programmes. As to whether nutritional factors can prevent initiation or extend the time to clinical disease remains to be proved.

Governmental agencies recommend the benefits of a diet rich in fruit and vegetables, a moderate red meat intake and regular exercise.

It is probably disappointing to mention this, but caution is indicated with regard to the efficacy of supplementation with specific dietary constituents on the basis that doseresponses and adverse effects are yet unknown, since few randomised controlled trials have been completed.

The medical community may also believe the preventive concept to be a little premature. Such trials are costly and finances are limited.

The concept that health gain can be derived from diet-related intervention initiatives, even if scientifically sound, could be difficult to finance.

Prevention must, however, be the keystone of medicine in the early decades of the twenty-first century, and discussion must centre on real costs, risks versus benefits of preventive strategies and whether it is a worldwide issue for the entire population, or merely appropriate for AfricanAmerican males, possibly Finns, who are recognised as high risk, or simply complementary to current practise in the management of clinical disease.

Such an approach is not in any way an alternative option to recognised clinical practice. If a preventive strategy could be offered to all men, however, only few would derive benefit, and any specific agent would have to be taken for a considerable period of time.

The use of tamoxifen as intervention therapy for breast cancer requires appropriate North American females to take the drug for a year to prevent one additional case [].

Compelling evidence suggests that isoflavonoids may well provide health benefit to Asian and other ethnic populations worldwide, either through the intake of soy protein by healthy, reproducing Asians, or of other legumes, by the people of India and South America.

A similar influence was recognised by Hirayama [] with regard to all cancers and lung cancer, with an impact even on those who smoked.

There were , subjects studied Definitive evidence from controlled trials may not be available for many years, so is it reasonable to suggest that since humans appear not to be adversely affected by exposure to these phytooestrogens, that a greater intake of soybean, or legumes, could be specifically recommended?

A similar argument could prevail for the polyphenols of green tea. Undoubtedly, the importance of a properly balanced diet is now better appreciated by the general public, but any suggestion for the need for specific dietary change must be accompanied by readily assimilated science.

The signal-transduction pathways that convey such salutary messages to the man-in-the-street must be very professional and the information scientifically sound, with consideration given to the renowned inability of the public to reach a consensus on almost any subject.

Open dissent through the media tends to generate scepticism, upholding the view that scientists rarely agree on any such issues.

Sporn [] has most eloquently argued the need for intervention initiatives directed to the early phases of carcinogenesis.

Lots of vegetables and fruit can be recommended for men through their early years and possibly the three post-pubertal decades, but is this sufficient?

The health benefits of statins as effective primary pre- 55 ventive agents against stroke [] and for those with hypercholesterolaemia, or at even moderate risk of coronary or cerebrovascular problems, might support their inclusion in such a capsule.

All this may be facetious comment and, clearly, care is important []. The science is never simple. Moreover, a metaanalysis of 19 trials and , subjects suggested [] that a high vitamin E dose could enhance all-cause mortality.

A goody bag capsule offers a logical way forward. But does society require unequivocal science from expensive and time-consuming, randomised trials, before forms of intervention can be established that do not compromise the credibility of medical science?

Another recent review describes the compelling evidence that dietary nutrients may prevent the development and progression of prostate cancer, with a meta-analysis indicating that consumption of soy food was associated with a lower risk of prostate cancer.

The impact of intervention therapy on the ageing process and mortality, or premature death, could be profound; analysis is therefore necessary on the costs vs benefits of such strategies, which would change social structure.

Research into the impact of dietary constituents on disease processes must be encouraged and appropriate controlled intervention trials quickly established as finance becomes available.

Keith Griffiths et al. Acknowledgements 9. The authors would like to thank Mr. David Griffiths, CompGraphics Services, Cardiff, UK, for the kind use of the illustrations provided for this chapter on prevention of prostate cancer.

Huggins C Introduction. National Cancer Institute, U. Scientific Publications Adlercreutz H Western diet and Western diseases: some hormonal and biochemical mechanisms and associations.

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Naslund M, Coffey DS The differential effects of neonatal androgen, estrogen and progesterone on adult rat prostate growth. Coffey DS Similarities of prostate and breast cancer: evolution, diet and estrogens.

Putzi MJ, De Marzo AM Morphologic transitions between proliferative inflammatory atrophy and high-grade prostatic intraepithelial neoplasia.

Prezioso D, et al Oestrogens and diseases of the prostate gland In press Watanaba S Large-scale, populationbased prospective studies in Japan.

Health Publications Hellendoorn EW Beneficial physiologic action of beans. Kuhnau J The flavonoids. A class of semiessential food components: their role in human nutrition.

Miksicek RJ Estrogenic flavonoids: structuralrequirements for biological activity. Wolf CR Chemoprevention: increased potential to bear fruit.

Can Med Assoc J Combs GF Antioxidants and disease prevention. In: Garewal HS ed Selenium and cancer prevention. Rayman MP Dietary selenium: time to act.

Howe GR Dietary fat and risk of breast cancer: combined analysis of 12 case-control studies. Waxman ed Molecular endocrinology of cancer.

Cambridge University Press, pp Parker RS Carotenoids in human blood and tissues. Lasnitski I The influence of A-hypervitaminosis on the effect of methylcholanthrene on mouse prostate glands in vitro.

Lasnitski I Reversal of methylcholanthrene-induced changes in mouse prostates in vitro by retinoic acid and its analogues. Pike JW Vitamin D3 receptors: structure and function in transcription.

The effects of castration on advanced carcinoma of the prostate gland. Stoner E The clinical development of a 5alpha-reductase inhibitor, finasteride.

Raghow S, Hooshdaran MZ, Katiyar S, et al Toremifene prevents prostate cancer in the transgenic adenocarcinoma of mouse prostate model. Risbridger G, Wang H, Young P, et al Evidence that epithelial and mesenchymal estrogen receptor-alpha mediates the effects of estrogen on prostatic epithelium.

Am Soc Clin Oncol, abstr 7 Gronberg H Prostate cancer epidemiology. Ross RK The role of molecular genetics in chemoprevention studies of prostate cancer.

In: Miller AB, et al eds Biomarkers in cancer prevention. Lopez-Otin C, Diamandis E Breast and prostate cancer: an analysis of common epidemiological, genetic and biochemical features.

Armstrong B, Doll R Environmental factors and cancer incidence and mortality in different countries, with special reference to dietary practices.

Moyad MA Dietary fat reduction to reduce prostate cancer risk: controlled enthusiasm, learning from breast or other cancers, and the big picture.

Skrabanek P Invited viewpoints. Taubes G The soft science of dietary fat. Kaaks R Energy balance and cancer: the role of insulin and insulin-like growing factor-I.

Yu H, Rohan T Role of the insulin-like growth factor family in cancer development and progression. Allen NE, Key TJ Plasma insulin-like growth factor-I, insulin-like growth factor binding proteins and prostate cancer risk: a prospective study.

Apter D, Vihko R Early menarche, a risk factor for breast cancer, indicates early onset of ovulatory cycles.

Montano MM, Jaiswal AK, Katzenellenbogan BS Transcriptional regulation of the human quinone reductase gene by anti-estrogen liganded estrogen receptor-alpha and estrogen receptorbeta.

Shen G, Guo-Zhen L, Zhengxin W Modulation of androgen receptor-dependent transcription by resveratrol and genistein in prostate cancer cells.

Bettuzzi S, Brausi M, Rizzi F, Castagnetti G, Peracchia G, Corti A Chemoprevention of human prostate cancer by oral administration of green tea catechins in volunteers with high-grade prostate intraepithelial neoplasia: a preliminary report from one-year proof-of-principle study.

Purohit V Can alcohol promote the aromatisation of androgens to estrogens? A review. Fahey JW, Zhang Y, Talalay P Broccoli sprouts: an exceptionally rich source of inducers of enzymes that protect agains chemical carcinogens.

Reed JC Dysregulation of apoptosis in cancer. Estrogenic effects of 8-isopentenylnaringenin on bone metabolism. Hirayama T Epidemiology of prostate cancer with special reference to the role of diet.

Sporn MB The war on cancer. Briel M, Nordmann AJ, Bucher HC Statin therapy for prevention and treatment of acute and chronic cardiovascular disease: update on recent trials and meta-analyses.

Prostate cancer has become the most common type of cancer among men and is the second leading cause of years of life lost from cancer in males [58].

Incidence estimates for the year indicate prostate cancer newly affected , men worldwide that year, , of whom have since died. Early detection and treatment of prostate cancer could theoretically reduce the burden of this potentially disabling and deadly disease.

However, because no conclusive, direct evidence demonstrates that early detection and treatment improve length or quality of life, the value of prostate cancer screening remains controversial.

Prostate cancer is primarily a disease of elderly men. There are large differences in the incidence of prostate cancer worldwide.

Incidence is very high in North America and northern Europe peaking at 63 per , white men and per , African-Americans in the U.

Despite these differences, the microfocal incidence of prostate cancer on autopsy is similar worldwide. Patients with very aggressive tumors, i.

Patients with relatively nonaggressive prostate cancer have a smaller risk of dying of the disease [39, 49]. Epidemiology and Regional Variation Prostate cancer is one of the few malignancies for which the incidence varies widely across different parts of the world.

Hsing and colleagues classified 15 countries according to their level of prostate cancer risk. Medium-risk countries included most of Asia [27].

The same group of investigators also examined trends in the incidence from to From to , when prostate-specific antigen PSA testing became widespread, the incidence in the high-risk countries ranged from 48 to per , person-years, while the incidence in low-risk countries ranged from 2.

In general, prostate cancer incidence rose in all countries during these years, with the increment increasing by between In the majority of men with pre-existing microfocal disease, the growth is stimulated.

It seems likely that these differences are only rarely due to genetic factors [36]. Among the environmental factors that are supposed to be critical in the development of prostate cancer, nutrition is suspected to play a major role.

Dietary habits vary greatly across the world. To date there have been 14 well-performed, case-control studies involving 4, prostate cancer patients and 5, control subjects [18].

Eleven of these studies have demonstrated a positive association between increased dietary fat or specific fatty foods and a higher risk of prostate cancer with an odds ratio OR of 1.

Epidemiological studies have suggested that vitamin E may also influence the development of prostate cancer [25]. However, the preventative effect of dietary components has not been definitely demonstrated in any specifically designed prostate cancer-focused studies that would withstand rigid scientific scrutiny.

Screening and Early Detection There is a worldwide attempt to improve the terrible outcome of prostate cancer.

If we diagnose prostate cancer in a late stage, it means an incurable status. Two approaches are accepted to achieve this goal at present: early detection and systematic screening.

The second is a planned examination of the affected population. The same clinical examinations are used in both methods.

Tenke et al. Table 5. The latest has not been used for years because of the very low specificity, invasiveness, and high cost.

DRE has low sensitivity alone, so it is not recommended for screening, but together with PSA testing, it improves the detection rate.

PSA is a glycoprotein with serine protease activity produced primarily by epithelial cells lining the acini and ducts of the prostate gland.

PSA is secreted into the lumina of the prostatic ducts and is present in high concentrations in seminal fluid.

Plasma concentrations are normally low but are increased by conditions that disrupt normal prostate structure and function i.

Androgens regulate expression of the PSA gene. Men who have regular PSA tests have a much higher chance of finding out that they have prostate cancer compared to men who do not have PSA tests.

With the use of an effective testing procedure, systematic screening shows a temporary but significant increase in the incidence, because we diagnose those patients whom we would otherwise diagnose clinically at a later time.

Thus, lead-time is produced, which can last from 4 to 10 years. After the second or third screening round, lowering of the incidence is to be expected.

The decreasing of mortality is expected only years after that. The cause of the lead time and the aggressive early treatment produce additional survival time, for which the 5 Prostate Cancer Screening disease-specific mortality is the only endpoint in evaluating the effectiveness of screening.

However, screening for prostate cancer remains controversial. In other countries, such as the United Kingdom, Austria, and the Netherlands, as well as in Scandinavian countries, there are no screening policies because solid evidence is lacking to support the effectiveness of screening and early treatment in terms of improving mortality.

Differences in healthcare systems and other economic factors also have to be taken into consideration when comparing countries with high levels of testing with those that have a lower level.

The American Urological Association and the American Cancer Society recommend prostate cancer screening annually, both PSA and DRE from the age of 50 years for men who have at least a year life expectancy, and to younger men who are at high risk.

On the other hand, according to the statement of the European Association of Urology guideline , at the present time there is a lack of evidence to support or disregard widely adopted, population-based screening programs for early detection of prostate cancer aimed at all men in a given population.

The use of PSA in combination with DRE as an aid to early diagnosis in well-informed patients is less controversial and widely used in clinical practice.

Effect of Screening The decision about whether to pursue early detection of prostate cancer is complex. In brief, the dilemma exists because many men with prostate cancer will die of other causes.

Breen Patrick H. Garrett Patrick H. Aspell Patrick J. Babin Patrick J. Buchanan Patrick J. Cleary Patrick J.

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Bolt Paul J. Deitel Paul J. Donald Paul J. Du Plessis Paul J. Dekker Paul Jeffcutt Paul J. Ferlazzo Paul J. Flory Paul J. Freeman Paul J.

Hazell Paul J. Welfens Paul J. Kenny Paul J. Lavrakas Paul J. Leslie Paul J. Mather Paul J. Mccarthy Paul J.

Ponganis Paul J. Quirk Paul J. Roarke Paul J. Rosch Paul J. Silvia Paul J. Teague Paul J. Thibault Paul J.

Chu Paul K. Feyerabend Paul K. Saint-Amour Paul K. Fidel Paul L. Gaston Paul L. Gavrilyuk Paul L.

Heck Paul L. Hedren Paul L. Jalbert Paul L. Marino Paul L. Barrett Paul M. Blowers Paul M. Borsenberger Paul M. Cobb Paul M. Dewick Paul M.

Franklin Paul M. Geffert Paul M. Getty Paul M. Griffin Paul M. Handley Paul M. Jones Paul M. Kennedy Paul Mladjenovic Paul M. Mcgarr Paul M.

Minus Paul M. Muchinsky Paul Moloney Paul M. Paulman Paul M. Rea Paul M. Selzer Paul M. Hackett Paul M. Worley Paul M.

Zelisko Paul M. Pearson Paul N. Biemer Paul P. Barach Paul R. Bartrop Paul R. Ehrlich Paul Reid Paul R. Epstein Paul Reynolds Paul R. Gregory Paul R.

Halmos Paul R. Johnson Paul R. Josephson Paul R. Kavieff Paul R. Krugman Paul-R. Krugman Paul R. Lawrence Paul R.

Prucnal Paul R. Rosenbaum Paul R. Scheele Paul R. Yost Paul Saccone Paul S. Boyer Paul S. Chung Paul Schutze Paul S. Evans Paul S. Fiddes Paul S.

Follansbee Paul S. Freemont Paul S. Royer Paul S. Williams Paul U. Kroskrity Paul V. Murphy Paul V. Bruno Paul W. Flint Paul W. Kahn Paul W.

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Colm Malone P. Commelin P. Coussot P. Sen P. Stangeby P. Tripathi Pc- Welt P. Dangelico P. David Marshall P. Davison P. Deiva Sundari P.

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Collins Peter M. Fayers Peter M. Gerhart Peter M. Ginter Peter M. Gruber Peter M. Kappeler Peter M. Kenny Peter M. Kettner Peter M. The same kind of nostalgia awaits you at Divo Island.

For our braver readers, we dare you to try out Booster or Catapult - at your own risk of course! The park is open from until on weekdays and until on weekends, but bear in mind that the more extreme rides open slightly later.

A handy local tip is that the prices drop after Nonetheless, Russian couples and groups of friends alike all come out here to make the most of the sunshine and enjoy themselves in a way you might think only children can.

As well as being a fun mode of transport it is also a convenient way to get around, and with so many beautiful features in the park to take in, strap on your wheels and head in any and every direction.

The football fans amongst you may relish the opportunity of viewing Zenit St. Interestingly, to settle on a design for the stadium, a competition was set up, and following a unanimous vote, Japanese architect Kisho Kurokawa won.

The refurbished, state of the art stadium will have a capacity of no fewer than 62, seats. The stadium is situated on the West of the Island and, hopefully, it should prove easy to find!

After exiting the metro station cross the road and head left. Take the first right, Batareinaya doroga, and continue down this road until you approach a roundabout.

Keep walking until you reach Yelagin Most, at which point you can turn left along naberezhnaya Martynova.

Here you can take a romantic walk alongside the river, making for a splendid view. Not only are there more shashliks here, but also a number of open air bars and restaurants, making a lovely alternative to the hot, stuffy city centre.

Walking straight ahead as you approach the end of naberezhnaya Martynova there is a Yaught club, displaying some of the finest yaughts St.

Petersburg has to offer. Of course it is also possible to use Yelagin most to cross over onto Yelagin Island; to find out more feel free to take a read of our other feature!

Ultimately, Krestovsky Island gives you the chance to jump off the tourist trail. Yelagin Island An island which is entirely parkland is the perfect place for a leafy stroll, echoing the sun drenched Vondelpark of Amsterdam or the dappled pathways of Paris.

The island lies between the Bolshaya and Srednaya Nevka; its western tip offers a view point of the Gulf of Finland and at its eastern shore a view down the Bolshaya Nevka towards mainland St.

Exiting Krestovsky metro station facing the park opposite, you should turn right and follow the road to the bridge to Yelagin Island.

Once there, following the winding pathways between the trees eventually reveals a well-kept lawn stretching towards the elegant bright white Yelagin palace peeping out from the trees.

A meandering stream of people of all ages can be found wandering or roller blading along the twisting paths, over bridges and under the dappled light of the trees.

The acres of gardens have faithfully preserved centuries old trees and special flora, and because of this some areas are indeed off limits.

Petersburg In Your Pocket Features delta, was inhabited by fishermen before the city was even founded.

It was presented to Peter the Great by Peter Shafirov in , his vice chancellor, but was taken back after Shafirov faced a death sentence in for embezzlement.

The radiant Yelagin Palace stands proudly at the head of a long sweeping lawn, where two majestic white lion statues, inspired by the Medici lions in Florence, guard a perfectly symmetrical staircase to the entrance.

It was designed by the Italian architect Carlo Rossi, who also designed the Mikhailovsky Palace of the Russian Museum, masterfully creating the pearly white curves, columns and dome nestled among the greenery of the park.

Retiring to his own island and Palladian Villa, Yelagin immersed himself in his study of alchemy. In later years, after complaining that she was no longer able to make day trips to other palaces, Maria Fyodorovna was given the current palace by her son, Tsar Alexander I, as a summer retreat.

The architect Carlo Rossi fastidiously redesigned every detail of the old villa, whose richly detailed neoclassical interiors were decorated by Giovanni Battista Scotti, Vasily Demuth-Malinovsky, and Stepan Pimenov.

Floral patterns, scenes from mythology and gilded carvings twirl across the elaborate ceilings and walls, dragging your eyes across every inch of intricate detail.

The first floor of the palace is used as an exhibition space for the Museum of Decorative and Applied Art and Interiors from the 18thth Centuries, established in During the siege of Leningrad in World War II, the palace was badly damaged by shelling, but was rebuilt in the s and now shows off its glamorous interior to the public.

Dedicated paths will lead you around the assorted bright white structures, decorated by beds of vivid flowers. In full bloom, the colourful flora, clean white walls and pockets of dazzling water will make for some unmissable photo opportunities.

The collection displays the work of Leningrad Glass Art Factory, operating from until , founded by the influential Soviet glass sculptor Vera Mukhina.

The factory produced innovative and colourful glassworks both for domestic use and also as experimental art. Around glass works are displayed in three halls in a simple and thoughtfully lit display that twinkles from every angle.

A whole corst-petersburg. TV screens run short documentaries about the glass making process, and a couple of installations and information placards explain the evolution of the fine art of glass making over the years.

It is well worth circling the island for the views across the waters of the Neva. Apart from an unfortunately noisy main road on the bank of the opposite shore on the north side of the island, you can look out across the placid waters towards other parts of the city, or indeed out to sea.

Proceeding to the very western tip of the island takes you to a viewpoint at the Gulf of Finland. Here you will again find two lions flanking a platform from which to enjoy the view of the glittering Neva joining the open sea.

On the site of a monument to architects at the eastern edge of the park, you can look straight down the Bolshaya Nevka curving inland towards the rest of the city.

The southern shores reveal St. You will feel pleasantly removed from the bustle of central Petersburg while enjoying the quiet natural side of the city.

To escape from the pollution and hubbub of activity in central St. Though more lavish grandeur can be found in the Hermitage, the clear elegance of Yelagin palace and its effortless harmony with its green surroundings offers a cultural element to a relaxing day trip to a charming park.

The luxurious interiors were designed by Hirsch Bedner Associates and the sense of luxury is supported by a unique wine list, live music and Mediterranean hospitality.

Close to the central city, the restaurant is located on Krestovsky Island in the middle of the Neva River delta giving guests a beautiful view which is particularly attractive as the sun sets over the Finnish Gulf.

The restaurant itself sits on the very edge of Swan Lake also known as Northern Lake , giving visitors the opportunity to watch these magnificent birds throughout the year.

With spacious interiors and set in the peaceful environment of Krestovsky Island - Il Lago dei Cigni is the ideal location for a quiet getaway from the stress and bustle of the city.

QA-1, Severnaya doroga 21, MKrestovsky ostrov, tel. Whilst the chef may not be French himself he clearly shares a strong affinity with the European nation, and his own take on classics such as Onion Soup were nothing short of exquisite.

Sip the wine and let yourself drift deep into the French countryside, leaving absolutely nothing to be desired.

The interior design emanates the same message that is reflected in the food; simplicity and elegance is everything.

QB-1, Nab. Martynova 16, MKrestovsky ostrov, tel. Soft background music, and friendly staff make for a lovely dining experience.

Tables are large and placed a good distance from each other. The menu is 26 St. Being close to the central city, Na Rechke is simultaneously convenient and remote.

This makes it an ideal location for a business meeting or a romantic dinner at the end of the day. QB-1, Ul.

Olgina 8, MChernaya rechka, tel. Petersburg is brimming with colourful, innovative and fun restaurants serving everything from traditional Russian to nouvelle cuisine.

To be sure of getting a table, make sure to book in advance. Be aware that many restaurants morph into bars and clubs in the later hours of the evening, so make early reservations if you want some peace and quiet.

Petersburg Riviera. The menu boasts an Italian, Russian and Japanese selection of meticulously cooked dishes presented by suave waiting staff, and an on board bar offers a large collection of mostly Italian wines as well as various cocktails.

For not too extortionate fine dining in a beautiful setting, this will be one of your best bets in St. PASW Zimaleto The high ceiling and wide open space populated with stylish comfortable sofas will immediately put you at ease in this bar.

On Yuzhnaya doroga, along the south side of Krestovsky Island, the bar has outside seating on decking on all sides, and looks out onto the collection of impressive yachts on the Malaya Nevka.

Inside, a high wall of shelving behind the bar displays bottles of surely any drink that might take your fancy, and indeed the carefully concocted cocktails will help you to feel like the whole place is a luxurious beach hut.

A drum kit on a modest stage promises regular live music, big screens can be viewed in comfort from all angles, and a staircase promises a VIP area.

QB1, Yuzhnaya doroga 8, MKrestovsky ostrov, tel. Open until last guest. PAESW st-petersburg. Here you can try a wide variety of real Russian cuisine, which is made using local farm products, as well as homemade fruit drinks in interesting flavours, such as pumpkin , lemonade, and organic wine.

The meals are well presented, and wholesome, including dishes such acorns tiramisu and thistle soup. The basement restaurant has low ceilings and generates a cosy and relaxed atmosphere.

QE-2, Ul. Nekrasova 8, MChernyshevskaya, tel. Open , Fri, Sat - Dostoevsky is an elegant restaurant focusing on home style Russian cuisine.

The atmosphere is chic and comfortable at the same time. Candles on the tables, soft lighting and crisp tablecloths give this place a warm and friendly glow.

There is live music on Fridays and Saturdays. Here you can taste a variety of traditional Russian dishes, with a decent selection of vegetarian food and a reasonable kids menu.

Many people though come to Idiot simply to absorb the atmosphere, and to drink. Guests are given a complimentary mini-shot of vodka, while the cordial english speaking staff hand you the Dostoevsky inspired menu; then, during happy hour - , you get two draught beers or glasses of house wine for the price of one, plus the complimentary vodka.

Quite the deal! QC-3, Nab. PTASW www. Iron candelabras give the room a medieval glow, while the crisp creamy tablecloths lend things a romantic touch.

The menu is truly Slavic and will satisfy anyone looking for a good fill of wholesome Russian food. Meat is king and there is a broad choice of succulent meaty cuts as well as delicacies such as tongue and liver to be found in the extensive menu.

QD-3, Voznesensky pr. The service and homely atmosphere, complete with toys and crayons for the kids, make this a thoroughly enjoyable experience.

QC-1, Ul. Lenina 18, MPetrogradskaya, tel. The atmosphere is cosy and warm, softly lit with candles so you can settle back, order your meal and be enthralled by the musicians with their charming, personality packed star singer.

They offer an array of delicious fish and meat dishes, all exquisitely presented and served. QD-3, Nab.

Open - , Wed Sun - Petersburg In Your Pocket Where to eat Olivie Named in honour of the famous Russian salad, of which various types are served here in abundance.

Olivie is located within a five minute walk from Palace Square, directly opposite the Admiralty. This restaurant is perfect for every mood, every occasion and every company.

QD-3, Admiralteisky pr. Add to that a wonderful historical decor and a menu written in old Russian to go along with said decor.

The fish was some of the best in the city, extremely fresh and full of flavor straight from the grill.

Traditional Russian specials like borsch and potato pancakes draniki are as good as any Russian babushka can whip up. QD-3, Mal.

Open Closed Fri, Sat. QD-2, Nab. The oriental style interior is completed by Indian tapestries on the floor.

Definitely worth sampling is its delicious naan and poppadom. Longtime Indian resident in St. Petersburg Ravi runs the show around here and is determined to make it a great success.

QC-2, 1-ya liniya 18, MVasileostrovskaya, tel. The interior has been decorated in the traditional Chinese style with the walls decorated with traditional paintings.

Quiet background music adds to the refined Oriental atmosphere. The master chef produces not only his favourite Szechwan and Cantonese dishes but also popular dishes from India and Thailand.

The central location makes this one of the most convenient Chinese restaurants to visit in St. Be prepared to take your time over the meal and expect to use chopsticks!

Petersburg resident and chef Sumit Gupta took the courage to open his own Curry House in the Northern Capital, which we think was a great idea!

Curry House is a perfect addition to the cities food scene serving food from all compass points off India.

The menu is extensive and we really enjoyed the big variety we ordered: Samosa, Murg Tikka Muglai, Palak Paneer, Punjabi Chole marinated chick peas served with plain rice and off course butter naan.

Like any Indian restaurant Curry House offers a wide choice of vegetarian dishes. QC-3, Ul. Glinki , MSadovaya, tel.

Not speaking English or Russian, the friendly chefs communicate with diners using their mobiles, serving up flavorsome authentic dishes with impressive culinary style to diners rather than thrown at you, unlike other typical Teppanyaki restaurants around the world.

With tables that can sit up to eight people, this is a great place to fuel up before heading out for a night on the town. The restaurant serves genuine Russian food, which is both tasty and filling.

The staff are attentive and provide excellent advice on the best combinations of food and drink. The final result was well worth the wait.

This is a lovely place to visit if you want to spend an afternoon or evening in quiet conversation.

QF-2, Tverskaya ul. The menu itself is mainly Thai-style dishes with scattered bits of Chinese, Indian and Japanese offerings. In general, we recommend filling up on an assortment of the yummy starters, particularly the dim sum or one of their big brothy noodle soups.

QD-3, Bol. Petersburg and the interior is truly exquisite. Mops cultivates the appearance of elegant chaos.

It has a terrace and three rooms to meet varying tastes, offering you a cosy spot to smoke a hookah or to sing your heart away in the karaoke hall.

Rubinshteina 12, MMayakovskaya, tel. Open - , Wed, Thu - , Fri, Sat - PASW st-petersburg. They have all the usual favourites so you can try a couple and share amongst your buddies, whilst mopping up every last dollop of sauce with the thick naan bread.

The menu is original and mouth-watering, especially the clay-oven Tandoorispecialities. When cooked here, the meat acquires a delicious flavour and specific tenderness.

The soft naan breads are also highly recommended - especially the peshwari naan. PALVSW Beer Restaurants Bierstube Choose from a seat in the bright glass covered courtyard balcony or tuck yourselves in inside the wood and stucco countryside house themed centre of the restaurant.

Either way be sure to load up on beer snacks like calmari and fried cheese sticks before the main events, Bavarian and Czech cuisine inspired meaty heavyweights, arrive.

The fact that it is a good walk down the canal from the metro station means you have the chance to walk of all the calories after.

QC-4, Courtyard by Marriott St. Griboedova entrance via Kanonerskaya ul. This is a good place to stop of with friends to watch sport on a Friday evening, drink a few beers with brands from all over Europe, this should keep you busy all evening and unwind after a week of hard labour.

The menu offers your classic Italian favourites and is worth every rouble. Service is good an unobtrusive and the beer is enough to put anyone into a good mood, so you are bound to have a good time regardless of your company!

QE-3, Vladimirsky pr. PASW 30 St. The restaurant does not provide you with the fine dinning experience but the food is delicious, reasonably priced and has fast, efficient service.

The music is loud, and although some might find this off-putting, there is plenty of space for patrons and it is still comfortable to talk in small groups.

The bar has a solid wine list and offers a wide variety of beers including trappist and craft beers - just the thing to wash down a fantastic meal!

Vosstaniya 20, MPl. Owner Sergey takes specific pride in having four different kinds of lager available that he specially made based on his own favourites from Russia, Belgium, the Netherlands, Germany and other countries he has visited in search of exotic examples of his favourite beverage.

The bar itself is located a short walk from the Summer Garden and well worth a visit. The atmosphere is laid-back and it is easy to mingle with locals and expats alike.

QE-2, Gagarinskaya ul. Open - , Tue - Thu - , Fri, Sat - PAEW Next to Mariinsky theatre Dickens This British island near the Fontanka river has beer from all around the world, including more than ten on tap, and a lot of superior whiskeys.

The snacks and food are good too the chicken wings are our favourites and come in huge portions. Open - , Fri, Sat This bar looks like your standard European bar, but just wait till you see the beer menu.

Whether you are a connoisseur of good beer or are looking for something a little different Manneken Pis will turn your affection for beer into a religion.

This bar has a wide range Belgium and Dutch beers with 12 types of beer on tap and over types of bottled beer, including Trappist and boutique beers.

The staff are obliging and eager to share their knowledge of the mind boggling array of beer, while the food is excellent.

QMoskovsky pr. Open - , Fri, Sat - Amazing Pastry! Petersburg, pr. Rimskogo-Korsakova 43, www.

Petersburg, with over different kinds of craft and imported beers. This place is all about beer, it is non-smoking, and only minimal finger food is available.

This place is about what really matters - beer. Vosstaniya 55, MChernyshevskaya, tel. The bar carries on the same traditions as Dickens and you might even know Jimmy the barman.

The menu remains unchanged but the line of beer has been improved dramatically - more than 30 sorts of beer, including the ever popular craft beers.

Every Wednesday they have live rockabilly music. QC-1, PS, Maly pr. Trappists are an order of Catholic monks who live by strict rules, but brew fantastic beer in their monasteries in Belgium and Holland.

With an entire book filled with beer options ranging from affordable to over 2,Rbl, Trappist is definitely a beer place.

The food is also quite tasty with Belgian classics and traditional bar food to choose from. From Friday to Sunday, you can order fresh mussels delivered directly from the White Sea.

Radishcheva 36, MChernyshevskaya, tel. The twist at Baklazhan Aubergine are the touches of deep purple to the decor, wine bottles lining the walls and a market stall of sorts selling fruits and nuts near the entrance.

The food itself is standard Georgian fare with a few more innovative dishes. Stick with baked goods, such as their stuffed samsas and khachapuri.

Here they serve three different types of the dish and it is definitely worth trying as a warm and filling main course.

Megrelia is a historic province in the western part of Georgia where walnuts feature prominently in the cooking and they like their food spicy.

Other must-try-dishes include the rich and cheesy Megrelian khachapuri or the fragrant chakhokhbili spicy chicken stew.

QD-3, Sadovaya ul. Open 24hrs. The menu features a mix of well-spiced the food is not watered down for local consumption shashlyks, salads, khachapuris, and pretty much anything else you could want from the South Caucasus.

QD-3, Kazanskaya ul. On entering, you might even say too popular, the tables are spaced close to each other and it quiet conversation looks like it will be impossible, but somehow it works.

You feel like you in are in a busy, fun and thriving atmosphere. The menu includes European delicacies, Russian favourites and of course traditional Caucasian meals thrown in to spice things up.

Also at Moskovsky pr. QD-1, Mal. Posadskaya ul. The light menu offers a few salads, snacks and grilled items, all priced low enough, allowing you to order a variety of options to share.

QF-3, Konnaya ul. Open - , Sat, Sun - As well as tapas, the menu also offers a limited selection of mains and soups.

In the proximity of the beautiful Tavrichesky Park Kroo Cafe serves breakfasts from and keeps on going into the night. The well balanced menu is created by their French chef who is keen on buying his own products at the market, which only ads to the feeling that what you get is fresh.

QF3, Suvorovsky pr. Perfect for coffee or after-work drinks, this is a popular little place which can be relied upon for a short, sharp French fix.

The flavorsome food is sure to satisfy, and the prices are more than fair. Marata 10, MMayakovskaya, tel. The bar staff are pleasant and friendly, although the service is a little tardy.

The interior consists of bare brick arched columns which are both attractive and impressive, with plastered white walls.

A walkin fridge in one wall gives the staff access to a large array of food and acts as the one element colour in the bar.

Let it Bar offers a convenient, quiet place to have a drink with friends, but it has little to make it stand out of the crowd.

QE-3, Nab. Open - , Fri - , Sat, Sun - PSW www. The restaurant also offers a range of more contemporary meals, including burgers made from Ladoga pie, baked potatoes with fennel, smoked salmon and cottage cheese.

The chef has specialised in Mediterranean cuisine and has an offering of scallops and prawns.

For meat lovers there is an meat menu. PTASW st-petersburg. The basic menu also helps keep things uncomplicated in the kitchen, allowing the cooks to just focus on quality ingredients and in the end deliver tasty and satisfying meals, which are also value for money.

QF3, 2-ya Sovetskaya ul. PASW perhaps Moskva The rooftop location on the 6th floor of the upscale Nevsky Centre, draws in a dressier crowd of wealthier diners looking to soak up the fancy view.

The decor is done out in various shades of cream and the furniture is the muted and comfy yet expensive looking stuff.

Potted plants brighten the place up, as does fresh fruit at the open central cooking stations and while the menu looks over ambitious, hitting all corners of the globe.

The designers have realized an interesting and complex idea with transforming walls: if you want to sit alone and have no one bother you, you can ask the waiter to fully insulate your table.

The menu offers European dishes, as well as Italian cuisine which is so popular nowadays. Open - , Fri, Sat - , Sun - As the name suggests, the bar offers an extensive wine menu with bottles from around the world, while the modest food menu serves more to complement the wines available.

Tightly packed into two small chambers, the restaurant is crowded with memorabilia of the weird, the wacky and the wonderful.

The bizarre collection creates a quirky and lively atmosphere. Live music aids digestion while this smoothly running restaurant is overseen by the resident cat who ensures everything is in order.

This quaint restaurant offers a great atmosphere and stands out as being something different on the St. Petersburg scene. QE-2, Furshtatskaya ul.

Open , Sat, Sun - There is also a decent selection of wine, a relaxing atmosphere, especially with live music on the weekend evenings, as well as a friendly staff.

QC-2, Bol. The unusual interior structure offers two types of seating; a bright and sunny veranda area or a more discreet lounging den on the mezzanine.

QD-1, Petrovskaya nab. The menu is as small as the place itself, boasting a simple yet tasty choice of soups and salads but also a selection of fresh juices, pasta and wine and huge salads which come in bowls heaving with green leaves.

Given the size and how easy it is to sit and linger listening to the operatic soundtrack, it is definitely advised to book ahead.

The hotel in which this restaurant is located has seen over a century of history. This history can be felt inside, and not just through the old pictures of dancers of the famous Mariinsky theatre.

The modern interior and cuisine, with a mix of trendy recipes and traditional Russian dishes, makes for a perfect and relaxed lunch or dinner after roaming the city.

It is made from meringue, and is so light that it can be enjoyed after any amount of food. Sit near the windows to enjoy the view of the majestic St.

QD-3, Hotel Astoria, Bol. PTALW st-petersburg. The service is in a class of its own, the interiors are stunning, especially the original art deco stained glass windows and ceiling, and all the dishes are made with the absolute finest ingredients available.

Sunday brunch is also magnifique! The Caviar Bar and Restaurant subtly and unquestioningly proves that the culinary arts also have a home in Russia.

Not surprisingly, caviar makes many appearances on the menu, but never one that is out of place. Business lunch is served between - The sleek look of the restaurant is as sophisticated and minimalist as you can imagine and the display of wines on sale and the equally attractive staff selling them take centre stage.

The menu is an exciting adventure for the taste buds with all kinds of exotic flavours and unusual spices being combined together with top notch fish and meat, to give the diner something memorable and out of the ordinary.

PASW 36 St. Service is perfect and the atmosphere is every inch as glamorous and lively as you may hope. The menu is filled with local and European dishes, all given the finest French touches by the highly presentable chefs over in the open kitchen.

After examining the impressively long wine list be sure to sample one of their highly creative cocktails. QD-3, W Hotel, Voznesensky pr. With a focus on healthy meals, the limited menu offers no starters.

Instead it has a few salads, vegetable sides and some light mains - great for those watching their budget and waistline. QD-3, Gorokhovaya ul.

A restaurant with a great view of Nevsky pr. The second floor has a relaxed atmosphere and comprises a wine and tapas-bar.

It is used for literary events, meetings with writers and book presentations. A bookshop is also located here. QD-3, Nevsky pr.

PTAESW Arka The soft lighting, exposed brick wall and sky-lights create a chic, yet cozy ambience where you can sit and forget about life for a while.

A meter bar and an impressive selection of unusual cocktails make it an ideal place to meet up with friends or business partners for afterwork, or pre-going out drinks.

The menu includes a grill section with sets that are meant to be shared, as well as other traditional dishes prepared in an untraditional way, like the cappuccino mushroom cream soup.

And their kitchen is open until in the morning! The prices are reasonable compared to similar high-class bars and you are guaranteed to leave with a good impression.

QD-2, Bol. Konyushennaya ul. The Buddha-Bar restaurant brings the finest elements of the lounge-restaurant brand to Russia with a wide-ranging menu of fancy pan-Asian cuisine with French accents, an inimitable lounge music soundtrack and ultra-chic surroundings.

Flashy, classy and a little bit exotic, Buddha-Bar proves popular with the cocktails crowd and fans of pan-Asian cuisine.

QF-3, Sinopskaya nab. Aleksandra Nevskogo, tel. PAESW www. They also have a seasonally changing five-course special menu with specially selected wines, themed around a different wine-growing area of the world.

Booking is recommended. QE-3, Nevsky pr. This cellar accommodates up to 16 people but you are never alone since you are accompanied by different bottles of wine and 50 bottles of champagne.

On the menu you can choose among others between four different fondues. Next to the classical cheese fondue is a bourgogne meat fondue and a chocolate fondue, you can also go for the champagne and perigord truffle and cheese fondue.

If you are considering a romantic candle lit dinner for two, hidden away from the world outside, then this is a good bet.

QAdmiralteiskaya, Nab. Reky Moiky 22, MD-2, tel. Open Tue - Sat - PAUW st-petersburg. Printed on rough, brown paper placemats, the menu offers a succinct overview of popular European dishes with something for everyone from soups and salads to heartier fare - except perhaps sushi lovers.

The dishes are average at best, with the small serving sizes making them more as a snack food to be accompanied with the extensive alcohol menu.

Lomonosova 18, MDostoevskaya, tel. Open - , Fri, Sun - If your granny has as much taste as she does knick-knacks.

Each of the rooms has plenty of florals, books and decorative odds and ends on the wall, but the effect is homey rather than cluttered.

Staff are delightfully friendly and the menu boasts hearty, flavoursome risottos, pastas and dishes fresh off the grill or from the oven.

Portion sizes allude again to the generousity of granny and can easily be divided into two meals.

The location affords great views of landmarks across the river, including the Winter Palace, and the restaurant makes the most of this, with lots of windows, and terraces, giving a spacious feel.

The staff are helpful, and although the menu features fish dishes, there is also shashlik and salads on offer, as well as a good range of drinks.

It is a nice restaurant to sit and enjoy the view after visiting this historic area of the city. You will be greeted six floors up with a candid view of the nearby golden dome of St.

The interior is understated and the glass walls ensure that the view is the main focus. Classic European tastes dominate with Asian influences also given some attention and the fresh fish based dishes are particularly recommended.

In warm weather the rooftop terrace is an excellent venue for sunset cocktails or Sunday brunch.

QC-3, Pochtamtskaya ul. With meat being the main player we ordered the strip loin steak and it was perfect. The menu is quite diverse and we tried scallops, salads and a creamy beet soup with goat cheese, fresh-baked breads as well as tea cocktails with liquor.

The prices are similar to a top Manhattan steak house. QD-2, Konyushennaya pl. Petersburg, with the broad Neva River glimmering in the sun.

The good thing is, the food is not forgotten and is all tasty, served by friendly waiters and attractively presented. Prices are reasonable too.

The terrace offers excellent space for lounging and partying. When the weather does not allow you to sit outside, they have lots of space in their well designed restaurant the next storey down.

Keller Franziska, lic. Candrian Thomas, lic. Tonazzi Paul, dipl. Karpf Katya Buess Julia Kamishaj Qendresa Dia Aischa 97 12 97 09 97 50 97 47 97 36 97 61 97 16 97 40 97 06 97 32 97 29 97 41 97 02 Leu Susanne, lic.

Otto Oliver, lic. Crameri Dean, lic. Ringger Ralph, lic. Heller Tatjana, lic. Baumann Monika, lic. Zogg David, lic. Welti Manfred, lic.

Bergmann Alexandra, lic. Frei Rahel, lic. Frank Michael, lic. Wieser Hanno, lic. Scherrer Michael, lic. Kunzelmann Therese Bislin Cornelia Pfiffner Sandro Vogel Yanick Zimmermann Sarah 31 60 31 61 31 62 31 63 31 69 31 64 31 65 31 68 31 67 31 66 Gossner Pascal, lic.

Stammbach Matthias, lic. Stotz Philipp, lic. Thurner Patricia, lic. Baumgartner Katrin, lic. Altenburger Simone, lic. Geisseler Roland, lic.

Kasper Claudia, lic. Knauss Alexander, lic. Kaegi Adrian, lic. Gutzwiller Nicole, lic. Leiter Sekretariat Weder Ulrich, Dr.

Stierli Silvio, lic. Weilenmann Maya, lic. Harb Beda, lic. Freihofer Viviane, Dr. HSG Kena Andrea, lic. Goy Tatjana, Dr. Gross Peter, lic.

Zimmerli Monika, lic. Voser Pascal, lic. Bolliger Laura, lic. Leu Ursula, lic. Mez Bettina, lic. Winkler Volz Sabine, lic.

Mitarbeiter Stv. Leitung Finanzen Manhart Thomas, Dr. Frey Erika Diane, lic. Maerki Lisa, lic.

Schnyder Laurence, lic. Sutter Thomas, lic. Schori Abt Christine, lic. Bereichsleiterin Co-Abteilungsleiter Stv. Kramer Isabel, lic.

Bereichsleiter Stv. Huser Barbara Piccot Jaeger Catja, lic. Rohner Barbara, lic. Sidler Christoph, lic.

Abteilungsleiterin Psycholog. Mitarbeiterinnen Praktikantin Treuthardt Daniel, lic. Dingeldein Katrin, lic. Braunschweig Michael, Dr.

Seelsorger Prot. Werder Franziska Erb Thomas, lic. Graf Katharina, lic. Amtsleiter HR-Verantwortliche Wiss.

Abteilungsleiter Wiss. Bieri Rolf, lic. ETH Kaufmann Patrizia, lic. Walser Christina, lic. Abteilungsleiter Jur.

Abteilungsleiter, Brenn Beat, lic. Amtsleiterin 2. Schwarz Jacqueline, lic. Amtschef Stv. Amtschefin Langenauer Stefan, lic.

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Mitarbeiter Erschliessung Wild Matthias, lic. Lutz Fabienne, M. Suter Meinrad, Dr. Ulrich Mathias, stud. Oswald Elias, stud. Meier Dominic ab 1.

Erni Peter, lic. Demin Daniel, stud. Isler Eveline, lic. Restauratorin Jesche Ines, Dipl. Abteilungsleiterin, Leiterin Benutzung Wiss.

Mitarbeiterin Edition Ehedatenbank Sieber Christian, lic. Hugener Rainer, Dr. Klauser Ursina, cand. Grunder Karl, Dr.

Amigo Raquel, MLaw et lic. Tschopp Hrovat Barblina, lic. I Ziegler Maya, lic. Passigatti Prisca, lic. Marketingleiter, Kantonsrat Marti Peter, lic.

Schnider Peter, lic. Fischer Esther, lic. Magnin Jacqueline, lic. HSG Arbogast Andrea bis Jakob Heidi, lic.

Bosshard Markus, lic. Ferricchio Daniela, lic. Huser Regula, lic. Keller Philipp, lic. Schnell Christina, Dr.

Umegbolu Katarina, lic. Von Gunten Stefan, lic. Lt Frei Marcel, lic. Leiter Technik Stv. Caduff Renato, Ing. Leiter Kessler Harald, dipl. Zambelli Peter Gysi Alexandra, lic.

Bernet Livia, lic. Pfleiderer Jasna Schneeberger Michael, lic. Coelho Jordana, MLaw 86 01 86 02 86 10 86 20 86 30 86 31 86 41 86 50 Hirt Dieter 85 00 Shammas Oliver, lic.

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HSG Sidler Daniel, lic. Kauffrau, zugel. Revisionsexpertin Fischer Rudolf, dipl. Steuerexpertin Urwyler Walter, dipl.

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Teamleiterin Stv. Sektorleiterin Teamleiterin Front Office Stv. Teamleiterin Sektorleiterin Datenmanagement Stv. Sektorleiterin Stv.

Teamleiterin Weidmann Silvia, lic. Chef Mathis Gisela Wendel Matthias, lic. Chef Huber Robert Schenkel Thomas, lic.

Odathekal Georit, lic. Vassalli Christian, lic. Suter Esther, Dr. Baumann Markus, Dipl. Betriebswirtschafter HF Kohler Martin, lic.

Chef Wittwer Urs, dipl. Steuerexperte Klingler Karl, lic. Fachausweis Baumann Daniel Detsch Urs, lic. Marthaler Stefan, lic. HSG Alder Peter, lic.

HSG, dipl. Steuerexperte Urban Jakob, lic. Stauffiger Beat, Eidg. Fachausweis Hinterberger Rita, lic. Keusch Nicole, Fachfrau im Finanzund Rechnungswesen mit eidg.

Zingg Samuel, lic. Steuerexperte Huber Martin, lic. HSG, Finanzplaner mit eidg. Taxation Wolfensberger Thomas, lic. Steuerexperte Hanhart Vera, lic.

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Einsprachen Leiterin Abt. Wenger Andrea, lic. Dolder Markus, lic. Frischknecht Peter, lic. Informationsbeauftragter Stv. Meili Andreas, Dipl.

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Dimitrova Gabriela, Dipl. Ressortleiter Lauber German, Dipl. Weiss Hans-Jakob, lic. Caflisch Carlo, Dr. ETH, Bestellverlauf 30 Dipl. Schnider Peter, continue reading. Scheerer Hanne, med. Agustoni Mirko, lic. Walser Christina, lic. Violand Georges, Dr. Leiter Techn.

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