Under strong seismic actions, it is essential not only to prevent the collapse of bridge structures to ensure the safety of people on the bridge, but also to pay close attention to structural damage, in order to facilitate the rapid post-earthquake recovery of traffic functionality and repair processes. Prestressed concrete bridge piers have attracted considerable attention for their advantages in seismic performance. The internal prestressing tendons can provide effective restoring forces for the piers while controlling seismic damage, thus reducing residual displacements and enhancing the rapid post-earthquake functionality recovery of the bridge to a certain extent. This paper reviews recent advances in the seismic performance of prestressed concrete bridge piers from two aspects: cast-in-place concrete piers and precast segmental piers. First, the development background of prestressed concrete bridge piers is briefly introduced, followed by a summary of research findings on cast-in-place reinforced concrete piers incorporating vertical prestressing tendons. Then, the latest research progress on precast segmental piers with prestressed connections is presented, focusing on energy dissipation mechanisms, shear resistance strategies, damage control measures at the pier base, and theoretical analysis approaches. Finally, based on the current status of theoretical research, technological development, and engineering applications both domestically and internationally, the development trends of prestressed concrete bridge piers are summarized. Research findings indicate that, compared to conventional cast-in-place reinforced concrete piers, prestressed concrete piers exhibit significantly reduced residual displacements after earthquakes. In most cases, supplemental energy dissipation devices are required to enhance energy dissipation capacity, and local damage to the piers is reduced. Prestressed connection technology shows significant advantages in constructing self-centering rocking piers and multi-segment precast piers. Future research should focus on several key areas: numerical modeling methods for prestressed piers, performance-based seismic design of self-centering piers and their engineering validation, seismic and durability performance of prestressed high piers with segmental construction, anchorage and construction techniques for prestressing tendons, and the seismic performance of pre-tensioned prestressed concrete piers.