FOLH1 and Decreased total leukocyte count: Hematologic toxicity was frequent but mostly grade 1-2: anemia 66% (<sup>177</sup>Lu-PSMA) vs 58% (<sup>225</sup>Ac-PSMA), leukopenia 59% vs 57%, thrombocytopenia 47% vs 48%; treatment-related deaths were not observed.<h4>Conclusions</h4>In this observational experience, <sup>225</sup>Ac-PSMA and <sup>177</sup>Lu-PSMA achieved comparable survival and PSA response with predominantly mild-to-moderate hematologic toxicity.