I have resorted to moderating new registrations. I believe it is worth the effort because spam can be damaging, resulting in hard won registered users leaving your forum. So if I am in any doubt about the details of the new registrant I reject the registration.
I suspect they are all human spammers because I have nospam questions that no bot could answer. They often make a first post that is meaningful and vaguels on topic, then they go back and edit the post and insert a link. So if you are monitoring new posts by email you won't notice it. The spammers are usually from the Phillipines, Pakistan or India and I suspect they are in the SEO business.
I have now also started blocking IPs. I use
http://software77.net/geo-ip/ to check the IP location. If it's located in a country that I have no interest in getting traffic from I just block the whole CIDR