Prostate cancer with a normal digital exam?

Patient : I have a 49 year old friend with an increasing PSA which he was doing the watch and see technique. Now the PSA has doubled to almost 8 within the past 8 months and he is scheduled for a biopsy. Digital exam has always been within normal limits. He has been on a course of antibiotics in the past year to cure any possible infection he may have which didn't show any results (PSA levels remained the same). He is worried about cancer since his dad had it. Can he have cancer without an enlarged prostate?
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