What I do for my forums to help mitigate the spam are:
Have users verify email address to register
setup at least 2 or more questions for them to answer on the registration page
block new members from posting links & editing their profile (no home page in profile or editing their signature)
setup a user promotion to promote members to a less restricted basic group after 3-5 posts.
prevent users who haven't been promoted from showing up on the members list
and of course have cloudflare do a check on any member visiting the registration page
I've seen alot less getting through nowadays.
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