I've been using the Question & Answer Verification option for years, and it's extremely rare for a spammer to get through. When one does, I change the question, and I'm usually spam free for 6+ months.
This obviously works better when you know that "all" of your members speak the same language.
They still hammer my site though. Something like 50% of my hits are on the registration page, with china and russia being the worst offenders.
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