Alkylketene dimer (AKD), cationic starch (CS), and polyamide epichlorohydrin (PAE) were used in the modification of precipitated calcium carbonate (PCC), and the use of the modified PCC in papermaking was investigated. It was found that after the PCC was modified, the sizing effectiveness of AKD was enhanced; when PAE was added to the filler, it had better modified effects than when CS was added. When the addition of PCC and AKD were fixed at 20% and 1% (based on the dry weight of PCC), respectively, the retention of PCC increased from 42.5% to 54.6% when modified by 5% CS, and to 56.7% when modified by 2% PAE. The strength properties (tensile indices, burst indices, and tear indices), opacity, and air permeability of the filled paper were strikingly enhanced, while the brightness was slightly negatively influenced by the addition of PAE. The results indicate that the pre-blend modified method is a promising technique for papermaking in that it enhanced the properties of paper.