Compared to traditional single/double-row concrete cast-in-place piles or concrete walls commonly used in foundation pit engineering, pre-tensioned prestressed hollow concrete-filled steel tube piles (referred to as prestressed Steel Cylinder Piles, or prestressed SC piles) demonstrate superior advantages including high bearing capacity, light weight, enhanced stiffness, excellent crack resistance, and cost-effectiveness, indicating a promising future in foundation pit engineering. However, current research has paid limited attention to such piles. Only a few experimental studies have focused on their flexural performance. No studies have presented bearing behavior investigations considering soil–pile interactions and the differences between these kinds of piles and traditional piles. To address this gap, this paper conducts a systematic investigation into the bearing performance of prestressed SC piles. A refined finite element analysis model capable of accurately characterizing pile–soil interactions is developed to analyze the mechanical behavior. Subsequently, the elastic foundation beam method recommended by design codes is employed to analyze the internal forces and displacement variations of these piles during excavation. Finally, the predictions by the design code are compared against those from the refined model. Results shows that the established finite element model presents reasonable predictions on monitoring data and experimental results, with deviations in bending moments and deformations within the range of 10–15%; a comparative analysis of different pile types reveals that prestressed SC piles exhibit smaller horizontal displacements and higher bearing capacities; the bending moments and deformations predicted by design methods (elastic foundation beam method) are conservative, with the predicted values significantly higher than those predicted by the refined model.