I've also run servers with applications that send out automatic mails and there, problems were bigger. I think this is because there are a lot of mechanisms such as SPF that miss when an application simply uses sendmail. I've followed the archwiki instructions [1] mostly, a couple of years ago, and it works very reliably.
This won't help protonmail with abusing users but for a private server, it works well. I think a server also builds reputation over time.
But honestly I don't understand why it works entirely. However, I wanted to say that private mailservers are not doomed :)