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Dave Shanbrom thought he was crazy thinking about sex. He had cancer, and you were supposed to worry about life and death. But his was the prostate variety--he was one of 234,000 American men so diagnosed last year--and he’d heard about the side effects, no matter which treatment you picked. So he flirted with doing nothing. “I did consider, ‘Erections, cancer? Erections, cancer? Erections, cancer?’” he recalls.

Shanbrom is with 16 other men in a small conference room at the east campus of Los Robles Medical Center in Westlake Village. All have had prostate cancer. Some chose to treat it with surgery, others radiation, others hormones. Several tried what they used to call “watchful waiting,” now “active surveillance.” One fellow’s cancer had spread to the bone, to the hip. Then again, he’s 87.

“How old are you?” someone asks Shanbrom, who is seated at one end of the table in jeans and a white T-shirt. “Fifty-five,” he says, the youngest in the room.

He first came here months ago hoping the support group would help him choose a treatment. Now he’s back to report in. He says his wife had reassured him, “I’d rather have you for a lot of years”--meaning however he turned out. So he’d signed on for surgery in May, the robotic variety, at City of Hope Cancer Center in Duarte. Four weeks later, he’s already out and about, back on the road selling supplies to area bakeries.

Oh, yes, the sex business. His fears about that had grown worse at the hospital when he learned about another possible side effect. As if the likelihood of impotence wasn’t enough, “this unusual thing came up, that after this surgery guys can experience getting smaller”--what the Seinfeld crowd famously called shrinkage. “So I was a little bit concerned about that.”

Ah, but he says there was a twist, an unexpected ripple in post-care today for many prostate patients. Shanbrom explains how a nurse injected him with a rice-sized erectile-enhancing pellet while he was in the hospital, and how he was sent home with Viagra and succinct instructions from his surgeon, Dr. Timothy Wilson, regarding his sexual apparatus. Use it, he ordered, as soon as you possibly can.

Actually, Shanbrom says, Wilson’s precise words were, “If you don’t use it, you lose it.”

It wasn’t long ago that prostate cancer often was discovered too late to be treated successfully, and talk about sex would have seemed frivolous, at best. But the PSA (Prostate-Specific Antigen) blood test developed in the 1970s made early detection possible. The complication was that the nerve bundles that connected the brain, via the spinal column, to the penis were so close to the prostate--the gland that helps men produce seminal fluid--that they often were traumatized, if not nicked, during the operation, making impotence a common consequence.

In 1983 a Johns Hopkins doctor introduced a surgical technique to “spare” those nerves. And one potential remedy for impotence surfaced the same year when English physiologist Giles Brindley stunned a gathering of the American Urological Assn. in Las Vegas by dropping his shorts to demonstrate the impact when a smooth-muscle relaxant was injected into the penis. As counterintuitive as that sounds, relaxing the muscle is what allows blood to rush in, making the organ swell. The next leap forward was the 1998 introduction of Viagra, whose most effective spokesman was a prostate surgery patient, former U.S. Sen. Bob Dole.

Dr. Peter T. Scardino, chairman of the department of surgery at New York’s Memorial Sloan-Kettering Cancer Center, says today, even with a seemingly successful operation, “three months [afterward] most men are having trouble” obtaining erections. With patients not yet of Medicare age, though, about 6 in 10 will be “pretty damn normal” within two years, he adds, while three others will “need something” to help them and “1 out of 10 won’t recover.” The sequence is reversed with the other common form of treatment, radiation: Afterward, most men maintain sexual function at first, only to have what the commercials now call “ED”--erectile dysfunction--hit large numbers of them over the next five years.

The use-it-or-lose-it strategy for surgical patients stemmed from two studies, one in Italy giving patients the erectile-enhancing injections and another in the U.S. giving nightly doses of Viagra for months after the operation. Leading urologists agree that both studies were imperfect--the number of patients was too small, for starters. But animal tests and simple intuition reinforced the theory that maintaining blood flow to the smooth-muscle tissue inside the penis--especially the oxygen-rich arterial blood that fills it during erections--was healthier than subjecting it to “a long time of inactivity,” as Scardino put it. Although he acknowledges the approach “is much more a theory than a fact”--and there are skeptics in the ranks of urologists--Sloan-Kettering’s chief surgeon, the author of “Dr. Peter Scardino’s Prostate Book,” gives patients a two-page penile rehabilitation protocol instructing them to take half a 100-milligram Viagra every night from the time their catheter is removed, plus an occasional full dose. If that doesn’t work, they are to switch quickly to penile injections. It’s there in black and white: In the first month, they are to achieve “sexual stimulation . . . three times per week.”

“Yes, sure, a lot of men say, ‘I wasn’t having sex that often before,’” Scardino says. “I’ve certainly had men ask me to give them a prescription to take home to their wife to prove they really need this.”

Wilson, City of Hope’s supervising urologist who operated on Shanbrom, doesn’t specify the number of times per week. He simply preaches “the more frequent the better.” Meanwhile, the Duarte cancer center has launched its own study to compare how 200 prostate surgical patients (including Shanbrom) fare over 18 months when given either daily Viagra, injections or placebos. It also will test whether the newer robotic surgery produces better sexual recovery than open surgery, which uses several smaller openings for a magnifying 3D camera, suctioning device and the robot tool maneuvered via controls at a computer console.

As for shrinkage, a urologist up the coast is working on that one. San Francisco’s Dr. Tom Lue, author of “A Patient’s Guide to Male Sexual Dysfunction,” is perhaps the leading expert on the physiology of the male anatomy. One study found that 10% to 20% of prostate surgery patients complained of the condition joked about on “Seinfeld”--they were losing about an inch--and “those guys are not very happy,” Lue says. He’s been experimenting with injecting several agents, including a protein “growth differential factor,” into the area of the traumatized nerves. “We don’t know yet in humans. In rats, we just give one injection and they recover.” The best part for them? “They don’t have to pay.”

Lue has long studied the sex lives of rats and has observed that when the two sexes are put together, “the male will try to have sex as often as he can.” For three or four hours, that is. After that? “The male rats are completely exhausted and don’t want to have sex anymore.”

At the Westlake Village support group, Dave Shanbrom drops the news matter-of-factly. “I have,” he says, “all my functions back.” He also says, “I consider myself pretty lucky,” and that draws nods from the others, including group leader Ken Foster, a mechanical engineer who had prostate surgery 16 years ago. Back then, “they told you to wait a year and we’ll see what happens,” he says.

As the men compare notes, a figure lurks outside the conference room doorway, listening but not venturing in. It’s a petite blond woman--half most their ages--carrying her 6-week-old daughter. Only when others insist she join the group does she take a seat and explain why she’s come to this biweekly gathering where men talk in ways they rarely do.

Her name is Katie, she’s 36 and she says she’s here because of her father. His prostate cancer was diagnosed in January, but he has put off radiation treatments. She thinks she knows why too: Unmarried after two divorces, “I think he’s afraid of it affecting his sexual function,” she says. “As a woman, I don’t want to be acting as if this doesn’t matter,” she continues. “But I want to tell him, ‘You’re not going to be able to use your penis if you’re in a coffin.’”

The men throw advice at her. One points out that he might well be ordered to have sex. Others say she must be honest with him--treatment could well curtail his late-in-life bachelorhood. But get him in here. Let us speak with him. Your instinct is right. “The saying goes, ‘You can have life without sex, but you can’t have sex without life,’” adds Foster, the engineer. “The first thing you’ve got to do is stay alive.”

Foster lets the men talk about what they want, whether it’s sex, maintaining urinary control--the other major side effect--or new treatments. Whatever the advances, the American Cancer Society estimated that 26,000 men died of prostate cancer in the U.S. last year, making it the third leading cause of cancer deaths among American men.

Foster understands that a sex life is critical to many men, whether they’re 55, like Shanbrom, or a grandfather many times over, like Katie’s dad. Some have spent years trying Viagra--Cialis and Levitra too--or injections and vacuum devices. Maybe those helped, maybe they didn’t. Having had his surgery in the pre-pill era, Foster tried injections until he decided, when he was close to 70, that “this is not worth it.” He doesn’t mention this, though, on the night when another man is celebrating his continuing potency.

Besides, there’s a different wisdom to be shared, at the right time, by men such as Foster or Harry Pinchot, who heads the longest-running prostate support group in the area, in Marina del Rey, or William Reese, who runs one in the San Gabriel Valley. Reese is a former South Pasadena police chief and not someone you’d expect to see leading such soul-baring sessions. But he has a doctorate in education too, and these groups only work if everything is out there.

So he talks openly about how he was sixtysomething and already losing some of his steam when he had his surgery. Plus, they removed the nerves, making recovery of sexual function that much more difficult. But at 78, he doesn’t fret much about that.

What he says to men lucky enough to have a mate is that this ordeal can bring you closer in other ways. “A man has to adjust,” he says. “A man must love his wife with all his heart and embrace that.”

In the end, he’s saying, what can be more glorious than cuddling?

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Chat online with Dr. Tom Lue at 2 p.m. Monday, July 30, at chat.latimes.com