There are two particularly well established players i'm going to focus on - ChoiceMail One from DigiPortal Software and Qurb which has now been acquired by Computer Associates and re-branded as CA Anti-SPAM.    
 
The main difference between the two is Choicemail exists as a separate password protected (if required) application a bit like your firewall AND supports a number of different e-mail clients. Qurb/CA anti-SPAM on the other hand, is integrated into Outlook simply delivering SPAM to a "Qurb" folder for review. 
 
If you're an Outlook user, I doubt you would go that far wrong with either product but my personal view is ChoiceMail has the edge in configurability and features  - which means you'll hardly ever have to look at it anyway.
 
I don't think the Outlook integration Qurb offers is as much of a benefit as some other reviewers appear to. In fact I see it as a flaw if you wish to keep offensive SPAM well away from your e-mail client (and for example, your children). It does however mean that CA anti-SPAM is less likely to cause a system conflict with anti-virus products you may have running.
 
ChoiceMail features are summarised below:
My advice is to take a look at both, but spend more time exploring ChoiceMail thoroughly so you can understand just what it's capable of. It's the real big-hitter of the two in my opinion.
 
Click on the images to enlarge.
 
The ChoiceMail One application - showing the messages quarantined.
If you send to me and you are not on my Whitelist, this challenge e-mail will be sent to you by ChoiceMail. Note - I am using the feature to hide my source address. Clicking on the link in the e-mail takes you to the web page at DigiPortal......
The sender needs to complete this simple form. After they do so, an authorisation request is sent to me and if I accept, the original message is released from quarantine - and all subsequent messages will be allowed through as normal. It's as simple as that!
 
Midgley's Info
ChoiceMail v Qurb
NIGGLES
 
Choicemail has a couple of minor ones:
 
1. The service seems to take longer to start than I would expect at bootup.
 
2. There may be conflict (and resulting odd e-mail behaviour/lock-ups/timouts) with some anti-virus products, because it is also looking at e-mails BEFORE they hit your mail client.
 
Sometimes it can be enough to simply turn off the e-mail checking component of the anti-virus product (this won't weaken your protection significantly anyway) but Choicemail gets around the problem by having the ability to change the port numbers used for the connection between Outlook and Choicemail too. I've had to do this when I used to run Norton, and also when I saw the light and dumped it for Kaspersky.
 
From the ChoiceMail Admin Control panel, server settings (Fig 1), I'm running SMTP on port 26 instead of 25 (Fig 2), and Pop3 on port 111 instead of port 110 (Fig 3). You need to match these for each e-mail client account (Fig 4 showing Outlook) as these accounts are talking to Choicemail and not directly to your ISP's mail server anymore.  
 
             Fig 1                                             Fig 2                                                     Fig 3                                              Fig 4
 
Click on the pictures to enlarge.