McMaster University is currently the only supplier in the world of a medical isotope used to treat prostate cancer — raising concern about shortages in 2020.

McMaster Nuclear Operations has been able to keep up with global demand so far because it had stockpiled isotope iodine-125 in anticipation of a planned shutdown for maintenance from Dec. 23 to Jan. 6.

“We’ve now shipped all of that out,” said Karin Stephenson, manager of commercial operations. “We’re doing our best to make sure patients don’t go untreated and we’ll continue to rise to the occasion to the extent that we can.”

But she’s not sure how long they can provide double the usual amount of isotopes after the unexpected shut down of the Uzbekistan research reactor in November for repairs. Another reactor in Russia that makes this isotope is also offline.

“If the outage continues, it’s going to be a problem in the coming months,” she said. “We will not be able to keep up with the global supply.”

It’s significant because the isotope is used to make the seeds for a cancer treatment called low-dose rate brachytherapy. The internal radiation therapy puts the radioactive substance directly into the tumour.

McMaster normally creates enough to treat 200 patients a day, but right now, it’s supplying enough for 400 patients.

“It’s like a big puzzle we’re putting together to try to get as much product out as we can because the orders keep coming,” Stephenson said. “It highlights to the world that medical isotopes are critical to patients and they are critical to cancer treatment.”

China is usually McMaster’s biggest client followed by the United States, but the university is working to make sure patients all over the world can get access.

“We’ve taken the moral stance to be equitable,” Stephenson said. “We’re trying to really spread it around. We’re being very transparent.”

McMaster has been in this situation before when the same reactor in Uzbekistan shut down for roughly three months in 2017.

“We’ve been building up our capacity for a number of years to take on more of the market,” Stephenson said.

The university has also been looking for a second reactor to provide McMaster with raw material in case it has an unexpected shutdown itself.

“Having dual supply is critical,” Stephenson said. “It allows you to have continuity in the supply chain so customers never feel a dip and patients never go untreated.”

But it’s not easy to find another supplier.

“Making isotopes requires a lot of expertise, highly qualified personnel and facilities,” she said.

“There is only so many places in the world you can even make this isotope.”

McMaster has found another reactor to partner with, but it will be a months before it’s ready to go.

“The timing of this couldn’t be worse,” Stephenson said. “If it could have been a few months later, it would have been much better.”

In the meantime, McMaster will do what it can including having staff work weekends and over the Christmas holidays.

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Its shut down has been shortened to end Jan 2.

“Everybody is stepping up to the plate to do their part,” she said.

But it’s only a temporary solution. Permanently upping the supply requires major changes such as increasing the operation to 24 hours a day from the current 16. It takes time to implement adjustments because staff require two years of training. In addition, the operation is financially self-sustaining so it has to make sure permanent changes don’t hurt the bottom line.