Dear Dr. Roach: About six years ago, I was diagnosed with prostate cancer. I chose to have a high-intensity focused ultrasound (HIFU), which ultimately wasn’t successful. I was told that surgery after an HIFU was a high-risk option, so I chose to have radiation therapy to reduce the surgical risk of side effects like incontinence.

Prior to the start of the treatments, I was given an injection of leuprolide, presumably to interfere with testosterone production. There’s also an injection that is scheduled for a couple of months after the completion of the radiation. I asked if the second shot was really necessary and didn’t get a definite answer.

What’s your opinion? Not to mention, the cost of the first shot was $11,814, most of which was paid for by insurance. It’s no wonder that insurance costs as much as it does. It can’t possibly cost this much to manufacture the drug. — E.B.

Answer: I can’t answer your question about whether leuprolide is necessary for you without knowing more about your type of prostate cancer. For men with high-risk prostate cancer, this hormone-blocking treatment significantly improves the possibility of a good outcome.

For men who are at a low risk or a “favorable intermediate” risk, testosterone-blocking drugs aren’t usually recommended. I suspect that you have a less-favorable intermediate risk, where four to six months of testosterone-blocking treatment is usually given.

The insurance cost that you were quoted is a retail price, and insurance companies negotiate a price that is usually much lower. In fact, the charges that you see on a hospital bill have a limited relationship with reality. There are also generic versions available for less than $200. Finally, there’s a pill (relugolix) that is cheaper and doesn’t produce the pain of the shot. It may work slightly better and faster.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.