Advancements in prestressed concrete bridge technology have increasingly focused on sustainability in response to growing environmental concerns. This review examines recent innovations in integrating recycled concrete aggregates (RCA) and supplementary cementitious materials (SCMs) within prestressed concrete to conserve resources, reduce waste, and lower carbon emissions. Sustainable prestressing techniques, including the use of fiber-reinforced polymer (FRP) tendons and shape memory alloys (SMAs), increase the durability of prestressed concrete bridges, extend service life, and minimize maintenance needs, thereby reducing environmental impact. Key methodologies, such as lifecycle assessment (LCA) and performance-based design, are highlighted for their roles in optimizing structural performance while reducing the ecological footprint. Despite the benefits, barriers to widespread adoption remain, including technical limitations, economic challenges, and regulatory constraints. To address these issues, this review proposes further research on material development, updated design guidelines, cost?benefit analyses, and supportive policy initiatives. The findings confirm that integrating sustainable materials and advanced technologies in prestressed concrete bridge construction offers environmental advantages without compromising structural integrity. Collaborative efforts among engineers, researchers, policy-makers, and educators are essential to overcoming these barriers and advancing sustainable, resilient infrastructure.