Haven't sysadmins ideas on forum spam prevention changed since the late 90s? Why not just flag new user accounts that may be suspect for inspection, e.g. from known spam IP addresses or with suspect email names, monitor their posts, and block them if they spam?
Yes they have - and at the same pace, spammers fight against the different heuristics which are put in place.
On moodle.org, we've been fighting that battle for years and up until the last few weeks the 'flag to a moderator' plus blocking excessive links on initial posts was working relatively effectively. But in the last two weeks we've been fighting an influx which has been keeping the site moderators busy and causing great distress to our Spanish Moodle community, causing some community members unsubscribe out of frustration.
We would love to implement more elegant spam-fighting solutions but the fact is that it takes engineering effort and its a constant battle - you combat one style of spam and it makes its way through in another way. Rightly in my view, we're spending most of our engineering effort on making Moodle better rather than fighting the spammers - so it takes time to implement these spam-prevention solutions.
So one option we had in our arsenal which would be immediate, push button solution without engineering time was turning on some cloudflare features which are designed to help - its a push-button solution which had a chance of helping our Spanish community immediately. The jurys out on whether its done much good, but thats how we got there.
tl;dr good, fast, cheap - pick two