Objective: To identify the main promising methods of radiation diagnosis of pneumonia, including chest X-ray in children based on theoretical research using the e-Library and PubMed databases.

Materials and Methods: The description of the changes in this study is based on the analysis of the examination of children of different ages with a clinical picture of pneumonia, who underwent routine radiography, low-dose CT and ultrasound of the chest organs, and an artificial intelligence algorithm was used to analyze changes in the lung parenchyma as a result of the radiation study.

Results: As a result of the study, it was concluded that a multimodal approach is necessary in the diagnosis of pneumonia in children, the features of the X-ray picture, depending on age characteristics, and the availability and informativeness of routine chest X-ray in children of different ages was confirmed.

Discussion: The officially recognized main method of radiation diagnosis of pneumonia, the method of radiography, has certain limitations in the interpretation of radiological data in children, which requires further research into the optimization of this method. As a promising direction, the possibilities of developing a multimodal approach using low-dose CT, ultrasound of the chest organs to diagnose pneumonia in children, taking into account the age of the child and the use of several diagnostic criteria, are considered.

Conclusion: The search for reliable, reliable and highly sensitive methods for diagnosing pneumonia in children continues to be relevant. The main place is allocated to routine chest X-ray as the most accessible, informative and low-dose method of radiation diagnosis.

Introduction: Breast cancer screening has played a key role in the early detection of the disease and reduction of mortality rates. Modern technologies have significantly changed screening methods, enhancing diagnostic outcomes and expanding research capabilities.

Objective: Тo review contemporary approaches to screening, with a focus on the use of artificial intelligence (AI), which promises improved diagnostics and presents new challenges in clinical practice.

Materials and Methods: The analysis covers a variety of scientific publications and clinical data, including traditional methods such as mammography, and the latest developments in ultrasound and magnetic resonance imaging, as well as the contribution of AI.

Results: AI can significantly increase the accuracy of mammographies and other screening methods, minimizing false positives and enhancing the customization of procedures.

Discussion: The discussion emphasizes the role of AI in improving screening efficiency, although there are still questions related to ethics and data confidentiality.

Conclusion: The implementation of AI in breast cancer screening opens new prospects for diagnosis and treatment, requiring further research and development of regulatory measures.

Introduction: The frequency of detecting pancreatic cystic lesions (PCLs) has been increasing in recent years. Pancreatic cystic lesions represent a diverse group of changes with varying potential for malignancy. Despite advances in precision, modern diagnostic methods still require development and improvement for accurate identification, differentiation, and assessment of malignancy risk.

Objective: To clarify the diagnostic accuracy of various radiological methods in the detection and differentiation of pancreatic cystic lesions, as well as to assess their limitations based on an analysis of international literature data.

Materials and Methods: A search for scientific publications was conducted in the Google Scholar information-analytical system for the period 2009–2024 using the following keywords: «pancreatic cystic lesion», «pancreatic cystadenoma», «intraductal papillary mucinous neoplasm», «perfusion computed tomography of the pancreas», and «pancreatic radiomics». 44 publications were selected for analysis.

Results: Advanced diagnostic methods have increased the potential accuracy in assessing pancreatic cystic lesions, but differentiating their subtypes and detecting signs of malignancy remain challenging tasks. Existing clinical guidelines are characterized by variability and inconsistency regarding diagnosis and monitoring, highlighting the need for standardizing approaches to managing patients with pancreatic cystic lesions and the implementation of new diagnostic methods.

Discussion: Analysis of the available literature demonstrates that the similarity of radiological features among pancreatic cystic neoplasms complicates their accurate differentiation. Conventional imaging methods and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are limited by low reproducibility of morphological criteria and insufficient cytological material, particularly in small cysts, highlighting the need for the implementation of novel diagnostic approaches. Quantitative imaging methods capable of assessing tissue characteristics and microcirculation, including dual-energy and perfusion CT, as well as radiomics, which enables statistical analysis of texture features and improves the accuracy of preoperative diagnosis, appear particularly promising.

Conclusion: The integration of quantitative imaging methods, including radiomics, may enhance the accuracy of characterizing pancreatic cystic lesions and facilitate the selection of optimal patient management strategies, especially in cases with a high risk of malignancy and recurrence. Further studies on large cohort populations are required to standardize the implementation of these technologies in clinical practice.

Introduction: Acute cerebrovascular accidents (CVA), including ischemic stroke and intracranial hemorrhage, remain among the leading causes of mortality and long-term disability worldwide. The substantial workload placed on radiologists, combined with the necessity for prompt decision-making under time pressure, underscores the importance of integrating artificial intelligence (AI) technologies into the diagnostic process.

Objectives: To assess the diagnostic performance of an artificial intelligence model developed for the detection of acute ischemic stroke and intracranial hemorrhage on non-contrast brain computed tomography (CT).

Materials and Methods: This paper represents the results of a retrospective study. The test dataset comprised 263 anonymized non-contrast brain CT examinations of patients aged over 18 years, performed under clinical suspicion of acute cerebrovascular accident. Ground truth was established by two independent radiologists. The performance of the AI model was evaluated against the ground truth dataset using sensitivity, specificity, accuracy, and ROC AUC metrics. In addition, the accuracy of lesion localization and segmentation was analyzed.

Results: For ischemic stroke detection, the AI model achieved a sensitivity of 0.85, specificity of 0.82, and overall accuracy of 0.83 (ROC AUC=0.84). For intracranial hemorrhage detection, sensitivity was 0.82, specificity 0.81, and accuracy 0.81 (ROC AUC=0.81). Agreement between radiologists and the model’s proposed lesion contours was observed in 94.2% of cases, while concordance on lesion volume estimation reached 95.7%.

Discussion: The findings demonstrate that the AI model provides high diagnostic accuracy and may serve as a valuable tool for clinical decision-making. Nonetheless, the limited positive predictive value highlights the necessity of employing the model in conjunction with clinical context and expert interpretation.

Conclusion: The «Brain CT” AI model demonstrated strong potential for automated detection of ischemic stroke and intracranial hemorrhage. Its implementation could contribute to reducing the workload of radiologists and improving diagnostic accuracy in routine practice, contingent upon further validation and model retraining on larger and more diverse datasets.

INTRODUCTION: Diffuse gliomas are the most common brain tumors. Gliomas of high malignancy are characterized by a poor prognosis and require complex combined treatment. Amide proton transfer is a modern technique that makes it possible to visualize metabolic changes in a tumor and increase the effectiveness of an MRI scan.

OBJECTIVE: to evaluate the possibilities of amide proton transfer in determining the degree of malignancy of diffuse cerebral gliomas.

MATERIALS AND METHODS: The study included 73 patients with histologically confirmed supratentorial adult type diffuse gliomas of the who underwent surgical treatment at the University clinic of PIMU from 2023 to 2025. The study was performed on a Philips Ingenia Elite X 3T magnetic resonance imaging machine (the Netherlands). The study protocol consisted of a standard protocol and amide proton transfer-weighted images (APT-WI). The average, minimum and maximum values of the relative concentration of mobile amide groups in the central and peripheral parts of the tumor, absolute and normalized by unchanged white matter, were calculated. The Mann-Whitney test was used to determine differences between patient groups.

RESULTS: The absolute values of the relative concentration of free amide groups in the central part of the tumor were higher in comparison with gliomas of low malignancy: average — 2.68 [2.07; 3.30] and 1.44 [1.34; 1.92], maximum — 2.96 [2.37; 3.81] and 1.62 [1.49; 2.11], minimum — 2.34 [1.62; 2.86] and 1.25 [1.14; 1.47], p<0.05. Similar differences were also found in the perifocal area.— 1,58 [1,28; 1,90], 2,29 [1,85; 2,77], 0,95 [0,61; 1,16] — the average, maximum and minimum values, respectively, in diffuse gliomas of high malignancy and 1,02 [0,83; 1,11], 1,57 [1,21; 1.67], 0.61 [0.36; 0.79] in low-grade gliomas, p<0.05. The normalized values differed only in the central part of the tumor: 3,25 [2,32; 4,86], 5,58 [3,50; 16,42] — the average and maximum values in tumors with a high degree of malignancy and 2,19 [1,68; 3,60], 3,10 [2,36; 12,19] in low grade tumors, respectively, p<0.05. When comparing Grades 2.3 and 4 separately, a tendency was revealed to increase the values of the image signal weighted by amide proton transfer from Grade 2 to Grade 4, both in the central part of the tumor and in the peripheral.

DISCUSSIONS: Determining the degree of malignancy of a particular tumor in the preoperative period is one of the key tasks of radiology, as it allows for adequate treatment planning, improving living standards and increasing survival. The results of the study demonstrate the possibilities of amide proton transfer in the staging of glial tumors. The relative concentration of free amide groups, determined based on the signal intensity of APT-weighted images, increases accordingly to an increase in the degree of malignancy, which is probably due to a number of histological and metabolic differences in gliomas of different grades.

CONCLUSION: Statistically significant differences were found between the values of the relative concentration of free amide groups in the central and perifocal regions of glial tumors with different grades. The amide proton transfer method is informative in the study of patients with diffuse cerebral gliomas.

Introduction: When studying the venous-arterial balance of blood flow at the neck level with unilateral stenosis of the internal jugular veins, a strong significant relationship was registered between a decrease in the total values of the outflow of venous blood to the internal jugular veins and a decrease in the total values of arterial inflow through the common carotid and vertebral arteries. Considering the controversial assumption of possible reflex constriction of the main arteries of the neck, this study was undertaken.

Objective: The purpose of the study was to study the adaptive-compensatory manifestations of extra- and intracranial main blood flow and cerebrovascular (venous-arterial) imbalance in stenosis of the internal jugular veins using US and TСD.

Materials and Methods: The study included data from 114 people (50 with extrinsic compression stenosis, 27 with hypoplasia, 6 after ligation/removal of the internal jugular veins on one side and 31 in the control group). The ranking assessment of the clinical condition consisted of determining the sum of syndromes in the clinical picture of cerebral venous congestion, which is a component of idiopathic (isolated) intracranial hypertension (cephalgia, neurological deficit, epilepsy, vestibular disorders, asthenic syndrome). An ultrasound study was performed to determine the cross-sectional area, time-averaged blood flow velocity in the internal jugular, common carotid and vertebral arteries with subsequent calculation of volumetric inflow and outflow, an indicator of venous-arterial balance. Transcranial Doppler was performed to determine peak blood flow velocities in the middle cerebral arteries, straight sinus, and basal veins of Rosenthal with the determination of resistance indices and cerebrovascular reactivity (hypercapnic test) of the middle cerebral artery.

Statistics: Statistical calculations were performed in STATISTICA 10.0 (StatSoft, Inc.). Descriptive statistics are presented as M±sd. The normality of data distribution was assessed using the Shapiro-Wilk test. The Kruskal-Wallis test was used to compare three independent groups. Comparisons between two independent groups were performed using the Student’s T test or the MannWhitney U test. Spearman’s rank correlation coefficient was used to assess the relationship between quantitative variables.

Results: An increase in blood flow velocity in the straight sinus (on average 26,37±0,88 cm/s) and a decrease in arterial inflow in the common carotid and vertebral arteries (48,05±8,99 ml/s) with a direct strong correlation (r=0,77) were found, due mainly to a decrease in the time-averaged blood flow velocity in the CCA (46–47 cm/s on average) from the average strong correlation r=0,4–0,48. Changes in other indicators are not reliable.

Discussion: Obstruction of venous outflow leads to intracranial venous stagnation, hypoxia and hypercapnia occur, which provoke a narrowing of both intracranial arteries and large arteries of the neck (unloading reflexes). This leads to a limitation of arterial inflow, which should ultimately provide compensation for moderate disturbances of cerebral venous outflow associated with stenosis of one of the internal jugular veins.

Conclusion: These changes are likely due to a neurogenic mechanism that regulates cerebral blood flow, depending on the functioning of the baroreflex to maintain vascular resistance and reactivity of medium and large arteries in response to an increase in perfusion volume when outflow is obstructed.

Introduction: Despite the decrease in the prevalence of hepatitis C, which became possible thanks to direct-acting antiviral drugs, the issue of using the optimal diagnostic method for both diagnosing fibrosis and assessing the regression of fibrotic changes in patients with chronic viral hepatitis C remains relevant.

Objective: The aim of the study is to determine the diagnostic possibilities of perfusion computed tomography of the liver in assessing the regression of intermediate stages of fibrosis in patients with chronic viral hepatitis C.

Materials and Methods: The study included 25 patients with cirrhosis and 25 patients who underwent examination for chronic hepatitis C in the infectious diseases department of the Siberian State Medical University; among them there were 13 patients (7 men, 6 women) aged 39–47 years with stages F1 and F2, who underwent antiviral therapy. After treatment, all underwent a repeat PCR study after 4 and 12 weeks. For dynamic observation, all patients underwent a repeated range of laboratory and instrumental research methods after a year. Statistics. Statistical analysis was perfomed using the Statistica 10.0 for Windows software package.

Results: The MTT (p=0.003) had a statistically significant difference between the hepatitis and cirrhosis groups. Statistically significant differences were obtained for the stiffness index (p=0.0001). Total and direct bilirubin, AST, ALT, GGT, total protein, glucose, prothrombin time, and alkaline phosphatase significantly differed; these indices were elevated in patients with cirrhosis. Patients in both groups had statistically different levels of total protein (p=0.0001), platelet indices (p=0.0001) and albumin (p=0.003); in the cirrhosis group, they decreased. After therapy, statistical analysis of clinical and laboratory data, the stiffness index, and perfusion indices before and after treatment was performed in 13 patients who achieved a sustained virological response. Blood flow (BF) statistically differed (p=0.04) when compared before and after treatment. In the comparative analysis, statistically different values were found for albumin (p=0.03), ALT (p=0.02), ALP (p=0.01), glucose (p=0.009), and total protein (p=0.01), stiffness index according to ultrasound elastography data (p=0,04).

Discussion: The use of perfusion computed tomography (PCT) is advisable in patients with chronic viral hepatitis C, since the results of this method provide information on the dynamics of perfusion parameters, indirectly reflecting the regression of fibrosis.

Conclusion: In the course of the study, we found that in patients with chronic viral hepatitis C, after the use of antiviral therapy, the BF value increases, which is a marker of improved blood flow and regression of fibrotic changes.

INTRODUCTION: Acute destructive pancreatitis is associated with high mortality rates. Although contrast-enhanced CT remains the gold standard for initial diagnosis, uncertainties persist regarding the timing and choice of drainage techniques for necrotic collections (ANC), and the impact of their structural characteristics on treatment outcomes is insufficiently studied. This retrospective study aims to comprehensively evaluate the capabilities of CT and MRI in the dynamic assessment of necrotic collections to optimize treatment strategy.

OBJECTIVE: Comparative analysis of CT and MRI capabilities in characterizing peripancreatic collections during different phases of necrotizing pancreatitis, assessment of the influence of necrotic debris on treatment strategy selection, and evaluation of treatment efficacy.

MATERIALS AND METHODS: A retrospective analysis of 150 patients (2023–2024) with necrotizing pancreatitis treated at the S.P.Botkin Moscow Clinical Research Center was conducted. Contrast-enhanced CT was performed at admission or within 3 days of disease onset, then every 7–10 days and preoperatively; MRI was performed when indicated. Each imaging study assessed the size of largest collections, presence of solid components, and communication with the pancreatic ductal system. Statistics: For comparison of quantitative data, Student’s t-test was used (data are presented as mean ± standard deviation). Categorical variables were analyzed using the chi-square test (presented as absolute numbers and percentages). The diagnostic value of the methods (CT and MRI) was assessed by calculating sensitivity and specificity. Statistical significance was set at p<0.05.

RESULTS: Peak sizes of peripancreatic collections were observed on days 7–9 after disease onset. Increased collection sizes after 2 weeks correlated with pancreatic duct injury signs on CT/MRI. Collections without debris showed rapid volume expansion in phase 1A followed by gradual resolution after 2–3 weeks, while debris-containing collections developed more slowly and maintained their volume longer. Debris presence correlated with higher disease severity and mortality but not with collection location. Surgical intervention significantly reduced collection sizes in most cases, except for percutaneous catheter drainage which showed markedly reduced efficacy when debris was present.

DISCUSSION: Comprehensive imaging plays a key role in the assessment of peripancreatic collections in destructive pancreatitis. Although CT remains the gold standard for initial diagnosis, MRI offers advantages in tissue differentiation and evaluation of collection structure at later stages. Structural features of collections, such as the presence of sequestra and communication with the ductal system, are of great importance for prognosis and treatment strategy selection. The presence of sequestra is associated with risks of prolonged persistence, infection, and ineffective percutaneous drainage. The combined use of CT and MRI allows for optimization of intervention timing, prediction of drainage effectiveness, and avoidance of unnecessary procedures, which ultimately may improve treatment outcomes.

CONCLUSIONS: CT accurately tracks peripancreatic collection dynamics, enabling objective disease monitoring. Late-phase MRI demonstrates superior sensitivity (89%) for detecting debris compared to CT (63%). MRI also shows higher sensitivity than CT (92% vs 21%) in identifying pancreatic duct communications. Combined use of both modalities optimizes surgical decision-making.

Introduction: Differential diagnostics of large heterogeneous adenomas presents difficulties due to the heterogeneous structure of the tumor. Of greatest interest is the differential diagnostics of heterogeneous adenomas with adrenocortical carcinoma (ACC).

Objective: Development of CT criteria for differential diagnosis of large heterogeneous adenomas and ACC, assessment of the presence of micro- and macrostructural fat as a sign of a benign process.

Materials and Methods: Retrospectively evaluated preoperative contrast-enhanced CT data in 67 patients with heterogeneous adrenal masses operated with histological verification of adenomas and ACC. The patients were divided into groups: 1 — heterogeneous and high-density adenomas n=40, 2 — ACC n=27. The following CT parameters were assessed: maximum size, contours, micro- and macrostructural fat/calcifications, minimum/maximum density in the native phase, density in the arterial/venous/delayed phases of the most and least dense areas, absolute and relative washout coefficient, presence of necrosis. Statistics: For statistical analysis, the Mann–Whitney test and the c2 test were applied. The diagnostic value of CT parameters was assessed using ROC analysis and logistic regression, with 95% confidence intervals calculated by nonparametric bootstrapping.

Results: When comparing the parameters by groups, it was shown that such parameters as the largest size, minimum density in the native phase, density of the least dense areas in the arterial/venous/delayed phases were lower in the adenoma group than in the ACC group. The presence of micro- and macrostructural fat was characteristic of the adenoma group, and the presence of necrosis was characteristic of the ACC group.

Discussion: The obtained results are consistent with previously published studies and clinical guidelines, refining the threshold values for large heterogeneous tumors, which confirms the feasibility of a comprehensive assessment of structural and densitometric features to improve the accuracy of differential diagnosis in clinical practice.

Conclusions: The above parameters can be used as CT criteria for differential diagnosis of heterogeneous adenomas with ACC.

INTRODUCTION: Bone strength is 60–70% depends on its mineral density. The remaining 30–40% of strength depend on the microarchitecture and composition. Osteoporosis is characterized by fatty involution of bone marrow. Based on this, it has been proposed to determine the amount of adipose tissue in bone as a fat fraction. Magnetic resonance imaging can be used to assess the fat fraction. The IDEAL MR sequence has not been sufficiently studied for the research of fat fraction and correlation with data of dual-energy X-ray absorptiometry.

OBJECTIVE: To investigate the possibility of using fat fraction derived from the IDEAL sequence in MRI in the diagnosis of osteoporosis for women over 50 years of age.

MATERIALS AND METHODS: Magnetic resonance imaging of I–IV lumbar vertebrae (IDEAL pulse sequence) and dual-energy X-ray absorptiometry data of 43 women over 50 years of age (mean age 63.9±8.4 years) were analyzed. MRI was performed on a GE Signa Voyager. DRA was performed on a Dexxum osteodensitometer. Fat fraction was calculated as the ratio of signal intensity at fat to signal from water.

Statistics: Pearson’s coefficient (r) was calculated for correlation analysis, ROC analysis was used, sensitivity and specificity were assessed. Values were considered statistically significant at p<0.05.

RESULTS: Fat fraction less than 0.66 corresponds to normal IPC values, fat fraction greater than 0.71 corresponds to osteoporosis (p=0.030). The sensitivity of MRI for detecting osteoporosis was 99%, specificity 87%, accuracy 88% (p<0.05). The correlation coefficient between IPC and fat fraction is negative and statistically significant (r=–0.316; (p=0.041). The correlation coefficient between T-criterion and fat fraction is statistically significant, negative (r=–0.300; (p=0.05). The correlation coefficient between age and fat fraction is positive, statistically significant (r=0.374; (p=0.015). The correlation coefficient between BMI and fat fraction is not statistically significant (r=–0.147; (p=0.347).

DISCUSSION: With decreasing bone mineral density the fat fraction increases, with decreasing T-score the fat fraction increases, with increasing age the fat fraction increases. No correlation was found between body mass index and fat fraction. The data of the study are consistent with the data of other studies.

CONCLUSION: IDEAL MR-sequencing is a promising technique for assessing fat fraction that can be used as a dose-free opportunistic screening of osteoporosis. Magnetic resonance imaging is widely used in the diagnosis of degenerative-dystrophic diseases of the spine. The IDEAL sequence lasts just over 3 minutes and can be added to the routine lumbar spine MRI protocol without significantly increasing the examination time, without prescribing additional examination methods, without exposure to ionizing radiation and with a significant increase in the amount of diagnostic information for detecting osteoporosis.

INTRODUCTION: Chronic venous insufficiency (CVI) is a pathological condition characterized by impaired outflow of venous blood from the lower extremities to the heart. CVI is one of the most common chronic diseases worldwide and is associated with high prevalence, age-related factors, geographical variations, and significant socioeconomic burden. In our study, we focused on differences in anthropometric parameters (internal lumen diameter) of the main subcutaneous veins of the lower extremities between healthy volunteers and patients with different classes of chronic venous insufficiency according to the CEAP (2020) classification.

OBJECTIVE: To determine the relationship between the diameters of the great saphenous vein (GSV) and the small saphenous vein (SSV) in both lower limbs and the stages of chronic venous insufficiency (CVI) C3–C6 according to the CEAP (2020) classification, as well as the number of affected main trunks.

MATERIALS AND METHODS: Ultrasound angioscanning was performed on a Mindray DC-70 (China) (5–12 MHz sensor) of the subcutaneous veins of the lower extremities of 165 patients: 20 volunteers without US-signs of damage to the venous system, 100 patients with varicose veins of class C3–C4а and 45 patients with active trophic ulcers of venous etiology that corresponded to class C6 according to the CEAP classification. The internal lumen of LSV and SSV was measured on both lower limbs at different levels. Statistics: The analysis was performed in SPSS 26.0. The normality of the distribution was tested using the Kolmogorov-Smirnov test. Group comparisons were made using Student’s t-test. The significance level was set at p<0.05.

RESULTS: LSV diameter significantly increases from normal (3.3±0,5 mm) to classes C3–C4а (6.8±1.6 mm, p<0.001) and C6 (8.1±1.7 mm, p<0,01) according to CEAP (2020); SSV is significantly wider in patients with CVI (up to 6.3 mm) compared with healthy volunteers (1.9±0.3 mm, p<0.001), but without significant differences between C3–C4а and C6.

DISCUSSION: According to the US study, the diameter of the LSV trunk significantly increases as CVI progresses to classes C3–C4а and C6 and can serve as a marker of disease severity. The absence of a significant increase in the diameter of the SSV trunk during the transition from class C3–C4а to class C6 emphasizes the leading role of LSV in the pathogenesis of trophic disorders in the soft tissues of the lower extremities in CVI. It was also observed that impaired venous outflow with a large number of affected mains significantly impairs tissue trophism in the zone of trophic ulcer formation.

CONCLUSION: Thus, as a result of our study using ultrasound duplex scanning of the lower extremity veins, we found that the trunk diameter of the great saphenous veins significantly increased with the progression of chronic venous insufficiency to CEAP (2020) classes C3–C4а and C6. This can also serve as an additional marker of disease severity, which is consistent with the clinical guidelines for this pathology. At the same time, the absence of a significant increase in the trunk diameter of the small saphenous vein during the transition from class C3–C4а to class C6 underscores the leading role of the GSV in the pathogenesis of trophic disorders in the soft tissues of the lower extremities in CVI. With the progression of the pathology involving a large number of affected main trunks, the impairment of venous outflow significantly worsens tissue trophism in the area of trophic ulcer formation.

Malignant neoplasms of the pelvic organs in men occupy leading positions in the structure of oncological morbidity. We present a clinical case of patient A., 84 years old, who had been under dispensary observation since 2008 after being diagnosed with prostate adenocarcinoma T2cN0M0 (Gleason 4+4). In 2009, the patient underwent maximal androgen blockade and radical prostatectomy. In August 2023, he presented with complaints of rectal pain and bleeding; diagnostic evaluation revealed an increase in PSA level up to 7.6 ng/ml, a tumor of the middle-upper ampullary rectum with mesorectal lymph node involvement, as well as a local recurrence in the prostate bed. Histological examination confirmed adenocarcinoma (Gleason 4+4) in the prostate bed and adenocarcinoma G2 of the rectum. The patient underwent proton radiotherapy to the rectal tumor, the zone of subclinical spread, and the prostate bed. This case highlights the necessity of a multidisciplinary approach in determining treatment strategies for colorectal cancer, especially in the presence of multiple adjacent tumors. The presented case demonstrates successful treatment of a patient with primary multiple metachronous cancer: recurrence of prostate cancer 14 years after surgery and a synchronous rectal tumor.