Prestressed concrete is commonly used in the construction of safety–critical structures such as large-span girders or slabs. The article focuses on post-tensioned elements, in which curvilinear multiwire strands are tensioned after concrete’s hardening to transfer the compressive force to the concrete. The overall idea is to confront external forces and achieve extended benefits, e.g. longer spans or reduced cracking. However, the design, construction and maintenance of such elements are particularly challenging because of their complexity, including spatial stress state in the anchorage zones and also the standard features of concrete structures like heterogeneity, material imperfections and, most importantly, local discontinuities (cracks). Reliable diagnostic solutions are therefore essential for both new and existing components. Distributed fibre optic sensing (DFOS) allows the measurements to be taken continuously over the entire structural length and its advantages have already been proven in civil engineering applications, especially those related to concrete structures. However, the novelty of the presented research lies in 1) simultaneous analysis of strains, stresses, cracks and displacements (shape changes); 2) direct comparison of results from monolithic sensors embedded in the concrete (for new structures) and those installed in pre-made near-to-surface grooves (for existing structures); 3)the application of the embedded composite strain sensor to the bi-directional analysis of the stress field within the anchorage zones; 4) possibility of strain transfer analysis between the cracked concrete, cable duct, injection and prestressing tendon during mechanical bending tests. The DFOS-based strain, crack and displacement results were also compared with reference measurements made with conventional spot techniques, achieving very good compliance. The research proved that a well-designed DFOS-based system, including appropriate measurement techniques, optical sensors, installation methods and post-processing algorithms, is the relevant tool for the diagnostics of post-tensioned concrete structures.